Management summary
British Society for Rheumatology in 2007 produced the Gout guidelines for management for the management of gout.
- Affected joints should be rested and analgesic, anti-inflammatory drug therapy commenced immediately and continued for 1–2 weeks
- Fast-acting oral NSAIDs at maximum doses are the drugs of choice when there are no contraindications
- Wth increased risk of peptic ulcers, bleeds or perforations, co-prescription of gastro-protective agents should follow standard guidelines for the use of NSAIDs and Coxibs
- Colchicine can be an effective alternative but is slower to work than NSAIDs. In order to diminish the risks of adverse effects (especially diarrhoea) it should be used in doses of 500mg bd–qds
- Allopurinol should not be commenced during an acute attack, but in patients who are already established on allopurinol, it should be continued and the acute attack should be treated conventionally
- Opiate analgesics can be used as adjuncts
- Intra-articular corticosteroids are highly effective in acute gouty monoarthritis and IA, oral, IM or IV corticosteroids can be effective in patients unable to tolerate NSAIDs, and in patients refractory to other treatments
- If diuretc drugs are being used to treat hypertension, an alternative antihypertensive agent should be considered, but in patients with heart failure, diuretic therapy should not be discontinued
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