Medication for acute attacks of gouty arthritis (traditional medications).
The following three types of drugs should be used early and in adequate amounts
1. Guidelines for colchicine in the treatment of gout.
(1) Both the ACR and EULAR guidelines recommend colchicine as the first-line drug for acute attacks of gout.
(2) Both ACR and EULAR guidelines recommend low-dose colchicine for the treatment of acute gout. The first dose is 1.0mg, followed by 0.5mg after 1 hour, and a prophylactic dose of 0.5mg qd/bid is given after 12 hours until the symptoms are relieved.
(3) Prophylactic treatment of acute gout attack: EULAR guidelines recommend low-dose colchicine 0.5mg qd/bid starting 2 weeks before uric acid-lowering therapy for 6-12 months.
The ACR guidelines recommend:
(i) For those with gout symptoms (within 3 months of acute gout attack, presence of gout stones, chronic gouty arthritis), low-dose colchicine is recommended for continuous prophylaxis.
②For those without the above-mentioned gout symptoms, low-dose colchicine prophylaxis is recommended for at least 6 months.
③For those who do not have gout stones, low-dose colchicine treatment is recommended for at least 3 months after the blood uric acid level reaches the standard.
(iv) For those with gout stones, low-dose colchicine treatment for 6 months is still required after the blood uric acid level reaches the standard. It can be combined with NSAIDs.
2. Guidelines for non-steroidal anti-inflammatory drug (NSAID) treatment of gout.
(1) Both ACR and EULAR guidelines recommend NSAIDs, including COX-2 inhibitors, as first-line drugs for the treatment of acute gout.
(2) Low-dose NSAIDS should be used continuously for 6-12 months to prevent gout attacks.
(3) In acute gout attacks, it is not necessary to choose which NSAIDS are more effective, but the side effects of long-term drug use should be considered.
(4) When acute gout attack, the key to choose NSAIDS class of drugs is to treat as soon as possible, starting with the maximum dose, the course of treatment 7-10 days.
3.Guidelines for glucocorticoids in the treatment of gout.
(1) Both ACR and EULAR guidelines recommend glucocorticoids as the first-line drugs for the treatment of acute gout attacks.
(2) Both the Chinese Society of Rheumatology and the Endocrine Society guidelines recommend glucocorticoids as second-line drugs for the treatment of acute gout attacks. Glucocorticosteroids should be chosen only when NSAIDS and colchicine are ineffective or when there are contraindications or allergies.
(3) For patients with acute gout who are unable to take oral medications, the ACR guidelines recommend intra-articular injections of hormones, static spot hormones and subcutaneous injections of ACTH.