Treatment of Acute Gout Flare

Immediate Flare Management

The American College of Rheumatology recommends initiating anti-inflammatory therapy immediately with colchicine, NSAIDs, or corticosteroids for acute gout flare, with choice based on renal function and contraindications 1, 2

The American College of Rheumatology suggests that ULT can be started during the acute flare rather than waiting for resolution, with allopurinol as the preferred first-line ULT for all patients, including those with CKD stage ≥3 1, 2, 4, 5, 6, 7
For patients with CKD stage ≥3, the American College of Rheumatology recommends using xanthine oxidase inhibitor over probenecid, and starting with a low dose of allopurinol (≤100 mg/day) and titrating as needed 1, 6
The American College of Rheumatology advises that when initiating ULT, concomitant anti-inflammatory prophylaxis (colchicine, NSAIDs, or prednisone/prednisolone) must be provided, with a duration of at least 3-6 months 1, 2, 6, 3

For patients with severe renal impairment or on dialysis, the American College of Rheumatology recommends dramatically reducing colchicine dosing, and considering corticosteroids as a safer alternative in advanced CKD 1, 6

The American College of Rheumatology strongly recommends starting with a low dose of allopurinol and titrating as needed, rather than using high-dose allopurinol initially, to avoid increasing flare risk 1, 6, 3
The American College of Rheumatology advises against skipping prophylaxis when starting ULT, and against stopping prophylaxis before 3 months, as shorter durations lead to flares upon cessation 1, 2, 7, 6