Fast Five Quiz: Gout Management

Bruce M. Rothschild, MD


August 16, 2022

Successful management of an acute gout flare includes rapid reduction in pain and joint inflammation. Several anti-inflammatory agents are effective for the management of acute gout flares; these include nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and colchicine. Selection should be based on prior symptom response to treatment, side effects, and patient comorbidities. Furthermore, NSAIDs are most effective when treatment is initiated within 48 hours from the onset of symptoms. Contraindications include peptic ulcer disease, uncontrolled hypertension or heart failure, NSAID allergy, and chronic kidney disease with a creatinine clearance < 60 mL/min.

Aspirin should be avoided and may prolong and intensify an acute attack. However, low-dose aspirin being used for cardiovascular disease does not need to be discontinued during a gout flare.

An interleukin-1 receptor antagonist should be considered only in patients with frequent gout flares and contraindications to NSAIDs, colchicine, and corticosteroids.

Urate-lowering therapy is recommended for the prevention of gout flares through dissolution of deposited monosodium urate crystals. Starting urate-lowering agents during an acute gout flare without anti-inflammatories will probably worsen the attack.

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