Topic: Antipyretics and analgesics
Question: Treatment of Acute attack of gout , give a brief note.
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Here is a detailed overview of the treatment of an acute gout attack:
Goals of Treatment:
– Relieve pain and inflammation quickly
– Prevent recurrent flares
– Avoid complications like joint damage, tophi, kidney stones
Non-Pharmacological Treatment:
– Rest and elevation of affected joint
– Cold compresses to reduce inflammation
– Avoid triggers like high-purine foods, alcohol, dehydration
Pharmacological Treatment:
1. NSAIDs (first-line):
– Indomethacin 50-150mg daily
– Naproxen 500mg twice daily
– Ibuprofen 600-800mg 3-4 times daily
2. Colchicine:
– 1.2mg once, followed by 0.6mg 1 hour later
– Then 0.6mg twice daily until flare resolves
– Reduce dose in elderly and renal impairment
3. Corticosteroids (severe cases):
– Prednisone 30-60 mg daily for 5-10 days
– Intra-articular steroids also effective
4. IL-1 Inhibitors:
– Anakinra 100mg daily
– Canakinumab 150mg subcutaneous
Urate-Lowering Therapy:
– Start once acute flare settles – xanthine oxidase inhibitors (allopurinol, febuxostat) or uricosurics
– Aim to maintain serum urate <6mg/dL
Lifestyle Modification:
– Weight loss if obese/overweight
– Limit alcohol, especially beer
– Hydrate adequately
Follow up regularly to prevent further gout attacks. Educate on triggers, lifestyle changes, and adherence to urate-lowering therapy
