Acute Gout Attack Management in Patients on Allopurinol

First-Line Anti-Inflammatory Options

• The European League Against Rheumatism recommends adding gastroprotection (PPI) if indicated by age >60, history of GI bleeding, or concurrent anticoagulation 1
• Colchicine 0.5-1.0 mg daily can be used as an alternative to NSAIDs, with a reduced dose of 0.5 mg daily in patients with renal impairment 1, 2, 3

Mandatory Prophylaxis During Dose Titration

• The American College of Rheumatology suggests initiating prophylaxis immediately with colchicine 0.5-1.0 mg daily or an NSAID, with a duration of at least 3-6 months after initiating or increasing allopurinol 1, 2, 3
• The number needed to treat with colchicine prophylaxis is 2, meaning one in two patients will be prevented from experiencing an attack 1

Prophylaxis Monitoring

• Colchicine causes significantly more diarrhea than placebo (RR=8.38), and monitoring for neurotoxicity with long-term use is recommended 1
• The British Society for Rheumatology advises adjusting colchicine dose for renal function as noted above 3

Target Serum Uric Acid

• The European League Against Rheumatism recommends a standard target of <6 mg/dL (360 μmol/L) for all patients, and a lower target of <5 mg/dL (300 μmol/L) for patients with tophi, chronic arthropathy, or frequent attacks 3, 4