Acute attacks of gout (Formulary)

For the management of acute gout consider:

• intra-articular methylprednisolone injection if one accessible joint affected.
• high-dose NSAIDs (used in the majority of patients) – the choice is based on GI bleeding risk and patient preference; naproxen may be used in place of indometacin (non-Formulary).
• oral prednisolone 20 to 40mg daily tapered over 2 weeks may be useful if above unsuitable.
• colchicine is an alternative, but can cause renal impairment and should be used with caution in GI disease. It is useful in heart failure and in those taking oral anticoagulants.

Refer to Department of Rheumatology guidance on the management of acute and chronic gout.