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Gout - Management
Overview of management

  • Confirm gout and exclude alternative diagnoses.
  • Assess the severity of the attack, and identify risk factors and any associated conditions.
  • Manage an acute attack of gout by prescribing a nonsteroidal anti-inflammatory drug (NSAID) (e.g. diclofenac, indometacin, naproxen) as soon as possible, with or without gastroprotection. If NSAIDs are contraindicated or not tolerated, consider oral colchicine. Advise the person to rest, elevate the affected limb, and avoid trauma to the affected joint. If the diagnosis is confirmed and there is no improvement in symptoms within 2–3 days, either try an alternative drug, consider combining treatment, or seek specialist advice.
  • Follow up the person 4–6 weeks after an acute attack of gout has resolved, and check the serum uric acid (SUA) level then.
  • Manage recurrent attacks of gout by starting allopurinol after two or more attacks within a year. Start allopurinol 1–2 weeks after the inflammation has settled and titrate the dose every few weeks until the SUA level is below 300 micromol/L. Use a low dose of an NSAID or low-dose colchicine to prevent acute attacks when starting urate-lowering therapy.
    • When starting allopurinol, check the SUA level and renal function every 3 months in the first year, then annually, and aim for a SUA below 300 micromol/L.
    • Consider starting febuxostat (an alterative second-line urate-lowering therapy) if allopurinol is not tolerated due to adverse effects or is contraindicated. If the SUA level is above 360 micromol/L after 2–4 weeks of initial treatment, a higher dose may be used.
  • Provide lifestyle advice on losing weight, modifying diet, reducing alcohol intake, increasing exercise, and stopping smoking.

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