Gout- 2020 Treatment Guidelines for Flares Flashcards
Gout flare management: Step 1
Assess the severity of the attack
“Mild” gout attack
Mild-moderate pain, only affects 1 or a few small joints, or 1-2 large joints
“Severe” gout attack
Severe pain involving multiple joints or multiple large joints
If the attack is “mild,” what can you start?
Monotherapy with an NSAID, colchicine, or systemic corticosteroid
For monotherapy, what can you supplement with?
Topical ice PRN
NSAID dosing for a gout flare
Full FDA-approved dose of an NSAID or COX-2 inhibitor, continue until the flare resolves
Colchicine dosing for gout flare
1.2mg x1, then 0.6mg 1 hour later
When can you NOT use colchicine for a gout flare?
If you take it for prophylaxis and you received acute gout regimen colchicine therapy in the last 14 days
Corticosteroid dosing for gout flare
Prednisone 0.5mg/kg PO QD x5-10 days at full dose, then stop
OR x2-5 days at full dose, then taper for 7-10 days, then stop
OR methylprednisolone dose pack
IA steroids also an option for larger joints, but dose depends on joint size
If the gout flare is severe, what can you start?
Combo therapy
Combo therapy options for gout flare
NSAID + colchicine
PO corticosteroid and colchicine
IA steroid, NSAID, and/or colchicine
IA steroid, PO steroid, and/or colchicine
Gout flare management: step 2 (from monotherapy)
Assess the outcome and determine if there is an adequate response
If there is a successful outcome, what do you do?
Counsel on patient education with diet and lifestyle changes, consider indications for ULT or adjustment of ongoing ULT if patient is already taking it
If there is an inadequate response, what do you do?
You can switch to alternate monotherapy or add on combo therapy
If there is STILL an inadequate response, what do you do?
Off-label therapies (IL-1 inhibitors, ACTH)
