Treating Acute Gout Flares
Acute gout is caused by an inflammatory response to monosodium urate monohydrate (MSUM) crystal formation—a temperature-dependent phenomenon, which can occur under conditions of elevated serum urate concentration. Gout flare is known as one of the most painful conditions in rheumatology, with pain intensity comparable to childbirth or long bone fractures. The condition regularly interrupts sleep, inhibits walking, and interferes with work and leisure activities.
The affected joint may become red, shiny, and very tender:
Gout flare may be accompanied by fever and—when associated with neutrophilia—it may give the clinical appearance of septic arthritis or infective cellulitis.
The American College of Rheumatology outlines the following principles for the treatment of acute gout:
- Treat acute attack with appropriate anti-inflammatory/analgesic therapy.
- Do not initiate urate-lowering therapy during the acute attack. Changes in uric acid levels (decreases as well as increases) may precipitate, worsen, or prolong the acute attack. However, if the patient is on urate-lowering therapy at the time of a gout flare, such therapy should be continued during treatment of the acute attack.