Gout guidelines arm patients and physicians with tools to fight painful disease
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About the Journal:
Arthritis Care & Research is an official journal of the American College of Rheumatology (ACR), and the Association of Rheumatology Health Professionals (ARHP), a division of the College. Arthritis Care & Research is a peer-reviewed research publication that publishes both original research and review articles that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with arthritis and related disorders, major topics are evidence-based practice studies, clinical problems, practice guidelines, health care economics, health care policy, educational, social, and public health issues, and future trends in rheumatology practice. The journal is published by Wiley on behalf of the American College of Rheumatology (ACR).
Management of Acute Gout
1. Affected joint(s) should be rested and anti-inflammatory and analgesic drug therapy commenced immediately, and continued for 1-2 weeks. Bed cages
and ice packs can be effective adjuncts to therapy.
2. A non-selective oral NSAID e.g. diclofenac, indometacin or naproxen at maximum dose is the drug of choice +/- a PPI when not contraindicated.
Etoricoxib +/- PPI may be prescribed if at least two non-selective NSAIDs +/- PPI are ineffective or not tolerated. Treatment should be continued until symptoms have resolved.
3. Co-prescription of a gastroprotective agent e.g. omeprazole or lansoprazole, is now recommended in all high risk patients prescribed a non-selective NSAID or a COX-2 selective agent.
4. Colchicine can be an effective alternative but is slower to work than NSAIDs. To minimise risk of diarrhoea doses of 500micrograms two to four times daily should be used. Treatment should be continued until symptoms have resolved or diarrhoea or vomiting occurs.
5. Allopurinol should not be commenced during an acute attack. Allopurinol should be continued in patients already established on it, and the acute attack treated as above.
6. Opioid analgesics can be used in addition to or instead of NSAIDs or colchicine.
7. Intra-articular corticosteroids are highly effective in acute gouty monoarthritis and can be used in addition to or instead of NSAIDs or colchicine when ineffective or not tolerated.
8. Oral, IM or IV corticosteroids can be used instead of NSAIDs. Oral, IM or IV corticosteroids can be used in addition to colchicine in those refractory to treatment. Oral Prednisolone 10-30mg /day for up to two weeks or Depomedrone 120mg IM stat may be used.
Author: Dr. Helen Harris, Consultant Rheumatologist
Approved on behalf of NHS Fife by the Fife Area Drugs & Therapeutics Committee, October 2010
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