Gout - Acute gout attack treatment

9 important questions on Gout - Acute gout attack treatment

What are the actions of ideal gout treatment?

Increase UA excretion OR decrease US production

What is the target of drugs for acute gout?

Target pain and inflammation

What type of drug is 1st line for acute gout?

a single anti-inflammatory: NSAID or systemic steroid or colchicine
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What type of treatment if for more severe gout?

Combo treatment: colchicine with NSAID or PO steroid

When is an intra-articular steroid injection helpful for gout?

When gout is localized to 1 or 2 joints

What is an alternative or 2nd line for gout?

Interleukin-1 antagonist SC injection

If an acute gout attacks occurs in a patient using chronic urate-lowering therapy (ULT) [allopurinol], what should they do?

Continue the ULT during the acute attack

When should colchicine be started? When can prophylaxis be started back after a treatment dose?

Start within 36 hrs of symptom onset (for treatment)
Treatment dose -> 12 hrs -> prophylaxis dose

Colchicine CI, warnings/side effects

CI in combo with P-gp or strong CYP3A4 INhibitor with renal and/or hepatic impairment
Myelosuppression, increased myopathy risk if taken with cyclosporine, diltiazem, verapamil, gemfibrozil or statins (avoid combo) 
Diarrhea, nausea, myopathy, neuropathy (dose dependent), decreased vit. B12

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