Treatment
3
Figure 4. Pharmacologic Antiinflammatory Prophylaxis of
Gout Attacks
Evaluate gout symptoms while on ULT
Continue pharmacologic anti-
inflammatory prophylaxis
Continued activity of gout
signs/symptoms
d
No signs/symptoms
Duration of Prophylaxis:
Treatment for the greater of:
• At least 6 months (A)
OR
• 3 months after achieving target serum urate appropriate for the
patient (B) (No tophi detected on physical exam)
• 6 months after achieving target serum urate appropriate for the
patient (C) (One or more tophi detected on physical exam)
a
e ACR did not specifically address case scenarios involving renal impairment adjusted
colchicine dosing for gout attack prophylaxis.
b
Lack of consensus: prednisone/prednisolone at doses above 10 mg/day.
c
is measure requires particular, continued attention to risk-benefit ratio.
d
Examples include: acute gouty arthritis in the past 3 months, presence of palpable tophus or tophi,
chronic tophaceous gouty arthropathy (with chronic synovitis) in the past 3 months.
Initiate Prophylaxis:
• Concurrent with, or just prior to, initiation of ULT
• Medication choices
Low dose colchicine
a
: Low dose colchicine, 0.6 mg once or twice daily
(Outside US: 0.5 mg once or twice a day) (A) OR
Low dose NSAIDs: with proton pump inhibitor (where indicated)
e.g., naproxen 250 mg twice daily (C)
Alternate treatment
b
:
Low dose prednisone or prednisolone
c
(≤10 mg/day) (C)
(Most practical for patients on chronic low dose steroids –e.g., transplant patients,
low dose steroids as alternate only if colchicine and NSAIDs contraindicated or
ineffective. Limit duration of low dose steroids.)
