Treatment of Urate Nephropathy in Patients with Acute Polyarticular Gout Attack

Management of Acute Polyarticular Gout Attack

For patients with urate nephropathy and acute polyarticular gout, treatment should include aggressive management of the acute attack with anti-inflammatory agents while simultaneously addressing the underlying hyperuricemia, with appropriate dose adjustments for renal function, as recommended by the American College of Rheumatology 1, 2
For severe polyarticular attacks, initial combination therapy is appropriate, particularly with involvement of multiple large joints, according to the American College of Rheumatology 1, 3
Recommended combination approaches include colchicine plus NSAIDs, as suggested by the American College of Rheumatology 4
Oral corticosteroids plus colchicine is another recommended combination approach, as per the American College of Rheumatology 3
Intra-articular steroids with any other modality can be used, as recommended by the American College of Rheumatology 1

Oral prednisone 0.5 mg/kg per day for 5-10 days at full dose then stop, or 2-5 days at full dose followed by 7-10 day taper, is recommended by the American College of Rheumatology 3, 2
Intra-articular steroids can be used for 1-2 affected joints, as suggested by the American College of Rheumatology 2
For severe cases, IV methylprednisolone at 0.5-2.0 mg/kg may be appropriate, according to the American College of Rheumatology 5
If not already on prophylactic colchicine, 1.2 mg followed by 0.6 mg one hour later, then continue with prophylactic dosing 12 hours later, is recommended by the American College of Rheumatology 3

Continue ongoing urate-lowering therapy (ULT) without interruption during the acute attack, as recommended by the American College of Rheumatology 2

Anti-inflammatory prophylaxis should be initiated with or just prior to ULT, according to the American College of Rheumatology 4
Low-dose colchicine (0.6 mg once or twice daily, adjusted for renal function) is first-line, as recommended by the American College of Rheumatology 4
Low-dose prednisone (<10 mg/day) is an option if colchicine and NSAIDs are contraindicated, as suggested by the American College of Rheumatology 4
Continue prophylaxis for at least 6 months, or 3-6 months after achieving target serum urate levels, as recommended by the American College of Rheumatology 4

Assess for resolution of acute gout symptoms and adjust therapy accordingly, as recommended by the American College of Rheumatology 2