Treatment for acute gout pain

Recommendation  

• NSAIDs are the drugs of choice for acute gouty arthritis.
• Colchicine is effective but is currently used less frequently because of its adverse effects
• An oral low-dose colchicine regimen may be used in patients who are able to take an oral medication but who have contraindications to NSAIDs (eg, moderate or more severe chronic kidney disease [CKD], active peptic ulcer disease, or a history of NSAID-intolerance) 

NSAIDs (1^st choice)

• Naproxen: 500mg BD / Indomethcin: 50mg TDS
• Prescribed for approximately a 7 to 10-day course or until 3-4 days after all signs of inflammation have resolved. 

COLCHICINE (2^nd choice)

• Recommended option in acute gout if the attack began within the past 36 hours. 
• Loading dose:1.2 mg of colchicine followed by 0.6 mg 1 hour later. This can then be followed, 12 hours later, by prophylactic colchicine dosing 0.6 mg once or twice daily that may be continued until the gout attack resolves. 
• If 1.0-mg or 0.5-mg tablets available, loading dose: 1.0 mg of colchicine followed by 0.5 mg 1 hour later. This can then be followed, 12 hours later, by prophylactic colchicine dosing 0.5 mg up to 3 times daily that may be continued until the gout attack resolves 

OTHERS (alternative if contraindicated)

• In patients with contraindications to the use of both NSAIDs and colchicine, preference is for intraarticular, oral, or parenteral glucocorticoids, depending upon the number of involved joints.

*Notes

• NSAIDs: Continue to take the medication throughout the attack and for 48 hours after the attack has finished 
• NSAIDs should be prescribed together with a proton pump inhibitor (PPI), which reduces the risk of the NSAID causing indigestion, stomach ulcers and bleeding from the stomach. 
• If have reduced kidney function, conditions such as stomach ulcers or bleeding, or who are using certain medications such as warfarin or treatments for blood pressure should avoid using NSAIDs.

REFERENCE:

http://emedicine.medscape.com/article/241767-treatment

http://www.uptodate.com/contents/treatment-of-acute-gout

http://www.nhs.uk/Conditions/Gout/Pages/Treatment.aspx

http://www.medscape.com/features/slideshow/gout#10