Drugs used in treatment of acute gout -
Management of Acute Gout Management should focus on first dealing with the acute attack and then giving prophylaxis to lower SUA and prevent fuher attacks. Oral colchicine given in doses of 0.5 mg twice or 3 times daily is the treatment of first choice in acute gout. It works by inhibiting microtubule assembly in neutrophils. The most common adverse effects are nausea, vomiting and diarrhoea. Oral NSAIDs are also effective but are used less commonly since many patients affected by acute gout have coexisting cardiovascular, cerebrovascular or chronic kidney disease. Oral prednisolone (15-20 mg daily) or intramuscular methylprednisolone (80-120 mg daily) for 2-3 days are highly effective and are a good choice in elderly patients where there is an increased risk of toxicity with colchicine and NSAID . The IL-1b inhibitor canakinumab is effective but extremely expensive and so seldom given. Local ice packs can also be used for symptomatic relief. Patients with recurrent episodes can keep a supply of an NSAID, colchicine or prednisolone and take it as soon as the first symptoms occur, continuing until the attack resolves. Joint aspiration can give pain relief, paicularly if a large joint is affected, and may be combined with an intra-aicular glucocoicoid injection if the diagnosis is clear and infection can be excluded. Ref Davidsons 23e p1015
Allopurinol
Colchicine
Pamidronate
Methotrexate
Immune system