Treatment
Table 2. Recommendations for Combination Therapy Approach
to Acute Gouty Arthritis
Initial combination therapy is an appropriate option for an acute, severe gout
attack, particularly with involvement of multiple large joints or polyarticular
arthritis (C)
Acceptable combination therapy approaches include the initial simultaneous use of full
doses (or, where appropriate, prophylaxis doses) of either:
1) colchicine and nonsteroidal antiinflammatory drugs (NSAIDs),
2) oral corticosteroids and colchicine, or
3) intraarticular steroids with all other modalities. (C)
For patients not responding adequately to initial pharmacologic monotherapy, adding a
second appropriate agent is an acceptable option. (C)
a
e panel was not asked to vote on use of NSAIDs and systemic corticosteroids in
combination, given concerns about synergistic gastrointestinal tract toxicity.
a
Assumes that the initial diagnosis of acute gout was correct and that the lack of an adequate response
was to an appropriate first-line therapy option.
3
Figure 2. Acute Gouty Arthritis Attack Management
Patient NPO
Intra-articular Corticosteroids:
Dose varies by joint size (B)
Intravenous/Intramuscular Corticosteroids:
a
Initial methylprednisolone 0.5–2 mg/kg
a,b
(B)
Initial ACTH:
25–40 IU subcutaneously (A)
a
Off-Label erapies in
Development
c
a
Can be repeated. Subsequent dose will be determined based on initial response.
b
Lack of consensus: IM triamcinolone acetonide monotherapy, and IM ketorolac NSAID therapy.
c
Off-label biologic IL-1 inhibitor treatment has not been approved by the FDA for gout at the time
this is printed.
Inadequate response
OR
