- Gout is one of the most common rheumatic diseases of adulthood, with a self-reported prevalence in the US recently estimated at 3.9% of adults (~8.3 million people).
- Ideally, pharmacologic treatment of an acute gouty attack should be initiated within 24 hours of onset.
- Either NSAIDs, colchicine or corticosteroids can be used for treatment of acute gouty arthritis.
- When colchicine is used, it is best to use earlier in the attack (within 36 hours) rather than later, and it should be dosed 1.2 mg, followed by 0.6 mg 1 hour later. Then it can be continued until the attack resolves
- Ongoing pharmacologic ULT should not be interrupted during an acute gout attack.
Descriptors of Acute Gout Attack
Table 1. Case Scenarios for Defining Acute Gouty Arthritis Attack Features
Severity of acute gouty arthritis attack and intensity of attack based on self-reported pain (0–10 visual analog scale)
Duration of the gouty arthritis attack since onset
- <12 hours after attack onset
- 12–36 hours after attack onset
- >36 hours after attack onset
Extent of acute gouty arthritis attack based on number of active joints
- One or a few small joints
- 1 or 2 largea joints
- 4 or more joints, with arthritis involving more than 1 regionb
- Acute gout attack involving 3 separate large joints is considered a form of polyarticular gout for this scheme of management
a Defined as: ankle, knee, wrist, elbow, hip, shoulder
b Regions defined as: forefoot (metatarsophalangeal joints, toes), midfoot (tarsal joints), ankle/hindfoot, knee, hip, fingers, wrist, elbow, shoulder, other