Key Points
` Gout is one of the most common rheumatic diseases of adulthood, with a
self-reported prevalence in the US recently estimated at 3.9% of adults
(~8.3 million people).
` Ideally, pharmacologic treatment of an acute gouty attack should be initiated
within 24 hours of onset.
` Either NSAIDs, colchicine or corticosteroids can be used for treatment of
acute gouty arthritis.
` When colchicine is used, it is best to use earlier in the attack (within
36 hours) rather than later, and it should be dosed 1.2 mg, followed by
0.6 mg 1 hour later. Then it can be continued until the attack resolves
with continued dosing based on renal function.
` Ongoing pharmacologic ULT should not be interrupted during an acute
gout attack.
Table 1. Case Scenarios for Defining Acute Gouty Arthritis
Attack Features
Severity of Acute Gouty Arthritis Attack
Intensity of attack based on self-reported pain (0–10 visual analog scale)
Mild ≤4
Moderate 5–6
Severe ≥7
Duration of the gouty arthritis attack since onset
Early <12 hours aer attack onset
Well-Established 12–36 hours aer attack onset
Late >36 hours aer attack onset
Extent of acute gouty arthritis attack
Based on number of active joints
One or a few small joints
1 or 2 large
a
joints
Polyarticular
• 4 or more joints, with arthritis involving more than 1 region
b
• Acute gout attack involving 3 separate large joints is considered a form of polyarticular gout
for this scheme of management
a
Defined as: ankle, knee, wrist, elbow, hip, shoulder
b
Regions defined as: forefoot (metatarsophalangeal joints, toes), midfoot (tarsal joints), ankle/hindfoot,
knee, hip, fingers, wrist, elbow, shoulder, other
Descriptors of Acute Gout Attack
