Patients who have multiple episodes of acute gout attacks per year or who have tophi on exam are candidates for uric acid lowering therapy. Treatment: Uric Acid Lowering Therapy Indications Oral corticosteroids can be used starting at 30-40 mg daily tapering over 10-14 days. Intra-articular steriods are useful if only one or two joints are affected and the treating physician is proficient in injecting those joints. Corticosteroids can be administered as an injection into the effected joint (intra-articular steroids) or given systemically (orally, such as prednisone or medrol). Corticosteroids: In patients with contraindications to NSAID use, corticosteroids are the next choice.Lower doses are much better received and may be used in combination with NSAIDs. High dose oral colchicine (1.2 mg followed by 0.6 mg every hour for 6 doses) is generally poorly tolerated because of GI side effects. Colchicine: Intravenous colchicine is associated with serious toxicities and side effects, so it should be used as an oral formulation only.Treatment should be discontinued when symptoms resolve.
NSAIDS: Commonly used NSAIDs during an acute gout attack include ibuprofen 800 mg three to four times daily or indomethacin 25 to 50 mg four times daily.The choice of which treatment is the right one for a particular patient should be made on the basis of the patient’s co-morbid medical conditions, other medications, and side effect profile. Treatment of pain and inflammation can be achieved with NSAIDs, colchicine, or corticosteroids (systemic or intra-articular). However, if a patient is on uric acid lowering therapy at the time of an acute attack, it should not be discontinued. It is important to note, that if a patient is not on uric acid lowering therapy at the time of an acute attack – then this is not the time to initiate such therapy. The goal of treatment during an acute gout attack is suppression of inflammation and control of pain.
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