Treatment Of Gout

Question 1

Treatment - acute attacks of gout

Answer 1

Usually treated with either:

(1st) Colchicine

(2nd) NSAIDs (excluding aspirin)

(3rd) Short course of corticosteroid (oral, intramuscular or intra-articular)

If all not suitable - interleukin-1 inhibitor can be considered

Question 2

Treatment - long term control of gout

Answer 2

Xanthine-oxidase inhibitors - Allopurinol, Febuxostat

Uricosuric drugs - Sulfinpyrazone, Benzbromarone (only if resistant or intolerant to first line)

Both may be used if no response to mono therapy

Question 3

Target serum urate level

Answer 3

Below 360 micromol/l

Question 4

When should treatment start?

Answer 4

At least 2-4 weeks after a gout flare has settled

If flares are more frequent - urate lowering therapy can be started during a flare