3
Figure 3. Pharmacologic Monotherapy Options for an Acute Attack
Full FDA- or EMA-approved dose of NSAID or a COX-2 inhibitor
a
(A)
b
– (C)
Continue initial treatment at full dose
c
until the
gouty attack has completely resolved (C)
a
Regulatory agency-approved doses for acute pain and/or treatment of gout
b
Naproxen, indomethacin and sulindac are approved by the FDA for the treatment of acute gout.
Other NSAIDs are also effective.
c
Tapering the dose in patients with multiple comorbidities/hepatic or renal impairment is an option.
Oral Colchicine
Is patient on prophylactic
colchicine already?
YES
Has patient received
acute gout regimen
colchicine therapy in the
last 14 days?
Oral Colchicine
d
(B)
1.2 mg, then 0.6 mg 1 hour later, then gout
attack prophylaxis dosing can be started,
beginning ≥12 hours and continued until the
acute gout attack resolves.
NO
Choose other therapy
(NSAID or corticosteroid) (B)
NO
YES
d
EULAR recommendations are for 0.5 mg colchicine orally three times daily when using colchicine to
treat acute gout. e doses recommended need to be adjusted down in the presence of significant drug
interactions and moderate to severe renal or hepatic impairment.
Corticosteroids
Consider intra-articular
corticosteroids (B)
START INITIAL TREATMENT
Oral: Prednisone 0.5 mg/kg per day
DURATION OF Rx: 5–10 days at full dose then stop (A), OR
for 2–5 days at full dose then taper for 7–10 days then stop (C), OR
Methylprednisolone Dose Pack, then follow-up treatment as indicated (C)
Intra-articular: Dose depends on joint size (with or without oral treatment) (B)
Intramuscular: Triamcinolone acetonide 60 mg, then oral prednisone as above
e
(C)
e
IM Triamcinolone acetonide was not recommended as monotherapy due to lack of consensus.
NSAID or Selective COX-2 Inhibitor
1–2 large joints For all cases of gout
Extent of joint involvement
