Management of acute gout

Better gouty arthritis treatment is a major concern for gout sufferers throughout the world.
My better gout treatment campaign is dedicated to improving medical and care procedures for all gout sufferers.
My correspondence shows that this is a worldwide problem.
British rheumatologists have completed some guidelines for the management of gout.

The aim of those guidelines is to:

develop concise, patient-focussed, evidence-based recommendations for the management of gout for doctors and allied heath professionals in primary care and hospital practice in the UK, which will also provide a useful resource for patients.

My aim is to provide a clear and concise gout patient guide that tells you what you should expect and request when you see your doctor about gout. To do this, I will analyze these guidelines, and other relevant publications, discuss them with you in the gout forum, and develop a simple gout patient guide.

I am still waiting to see the full guidelines, but the executive summary Full guidelines are at the link above, and they contain plenty of solid information that is vital to all gout sufferers. It does not matter where you live. The standards of gout care that you receive should be the best available. In this series of articles, I discuss the guidelines, with an emphasis on their relevance to gout sufferers.

In this article on gouty arthritis treatment, I focus on the guidelines specific to the management of acute gout. This relates to the stage of gout where you experience painful swelling in one or more joints. It is usually the point where you are first aware that something is wrong, and the point where most gout patients first seek medical attention.

Other guidelines relate to lifestyle changes after this acute stage, and management of later stages of gout. All these guidelines are supposed to be evidence based, but the report notes the lack of strong evidence in many areas of gout management. As they say, and we know to our cost:

Gout is a common disease both in primary care and hospital practice… many of the recommendations for treatment are based on expert consensus rather than research evidence and audits of practice suggest that treatment is very variable.

Most guidelines are graded according to the quality of evidence supporting them. The grades are:

  1. At least one randomized controlled trial
  2. At least one non-experimental descriptive study (eg comparative,
    correlation or case study), quasi-experimental study, or non-randomized controlled study
  3. Expert committee reports, opinions and/or experience of respected authorities

The acute gout management guidelines are:

  1. Rest the affected joints (C) and take analgesic, and/or anti-inflammatory drugs for 1 to 2 weeks (A).
  2. Maximum doses of fast-acting oral NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are the best if you can tolerate them(A).
  3. If you have an increased risk of peptic ulcers, bleeds or perforations, your doctor should also prescribe gastro-protective agents, following standard guidelines for the use of NSAIDs and Coxibs(A).
  4. Colchicine can be an effective alternative to NSAIDs, but is slower to work (A). To reduce the risks of adverse effects (especially diarrhea) it should be used in doses of 500 ?g, twice or four times per day (C).
  5. Do not start taking allopurinol during an acute attack(B), but if you are already taking allopurinol, it should be continued and the acute attack should be treated conventionally(A).
  6. You can take opiate analgesics as well as anti-inflammatories(C).
  7. Corticosteroids injections are highly effective in acute gout in one joint(B) and corticosteroids injections and tablets can be effective if you cannot tolerate NSAIDs, or nothing else seems to work (A).
  8. If you take diuretic drugs for hypertension, discuss alternative blood pressure lowering therapies with your doctor, but if you have suffered heart failure, diuretic therapy should not be discontinued (C).

If you are having, or have recently had, an acute gout attack, it is crucial that you review the bold guidelines (A) and make sure that you have received appropriate gouty arthritis treatment. If not, make an appointment with a specialist on the worldwide listing of rheumatologists.

The two (B) graded guidelines (5 and 7) are also important, and if they are relevant to you, discuss them with your doctor as soon as possible.

The italicized guidelines (C) are still very important, but they might not affect you, or your doctor might hold a different opinion. If you have any doubts about these issues, you must still discuss them fully with your doctor, or seek a consultation with a rheumatologist. You might also like to discuss them below.


  • [Comment consolidated from separate discussion]

    As for resting (Recommendation 1), I note that only C grade evidence is available to support this. Although, in my experience, resting the affected joint, particularly when raising it above heart level, can ease the pain, I’ve found that gentle exercise causes the joint to heal quicker. Often, I need to take ibuprofen to be able to tolerate the pain of exercising a swollen joint, but I try to keep this to a minimum.

    What was your first advice for coping with a painful gouty joint? Did you understand it? Did you follow it? Please share your experience here, or ask a question if you don’t understand what I’ve said.

  • More than another year has passed since I last looked at this topic, but it is still highly relevant.

    I’m reminded of some thoughts I had a few years ago, that I’ve recently reviewed as part of my website reorganization.

    I’ve often pondered if we should try to avoid the word gout! It is so strongly linked with bad practices and bad attitudes.

    Does anyone else think that gouty arthritis is best referred to as uric acid arthritis?

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