Gout
ICD-10 M10 · ICD-11 FA25
Managing Frequent Gout Flares When Colchicine, NSAIDs, and Corticosteroids Are All Contraindicated
Patients with gout who suffer frequent flares but cannot receive any of the three standard anti-inflammatory options — colchicine, NSAIDs, or corticosteroids (oral or injectable) — require a distinct treatment approach. This protocol applies when there is also no active infection present.
Clinical Scenario
- Frequent gout flares
- Contraindication to colchicine
- Contraindication to NSAIDs
- Contraindication to corticosteroids (oral and injectable)
- Absence of current infection
Treatment Approach
When all three standard flare therapies are contraindicated, current evidence supports the use of an interleukin-1 (IL-1) blocker to manage the acute attack. The complete agent selection and regimen are specified in the full protocol.
Goal: resolution of acute gout flare with relief of joint painReferences
DOI: 10.1136/annrheumdis-2016-209707
- In patients with frequent flares and contraindications to colchicine, NSAIDs and corticosteroid (oral and injectable), IL-1 blockers should be considered for treating flares.
- Current infection is a contraindication to the use of IL-1 blockers.
- Two RCTs have reported that the anti-IL-1β monoclonal antibody canakinumab (150 mg subcutaneously, one dose) was superior to triamcinolone acetonide (40 mg subcutaneously, one dose) in reducing pain in patients with flare with contraindication, intolerance of or non-response to NSAIDs and/or colchicine.
- A case series also suggest that this IL-1 receptor antagonist, administered subcutaneously at 100 mg for 3 days, could be effective in reducing pain in patients with acute attacks.