Editing Gout (section)

==Treatment==
The initial aim of treatment is to settle the symptoms of an acute attack.<ref name="pmid16707532">{{cite journal  |vauthors=Zhang W, Doherty M, Bardin T, et al |title=EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT) |journal=Ann. Rheum. Dis. |volume=65 |issue=10 |pages=1312–1324 |date=October 2006 |pmid=16707532 |pmc=1798308 |doi=10.1136/ard.2006.055269}}</ref> Repeated attacks can be prevented by medications that reduce serum uric acid levels.<ref name="pmid16707532"/> Tentative evidence supports the application of ice for 20 to 30 minutes several times a day to decrease pain.<ref name=Moi2013>{{cite journal |last1=Moi |first1=JH |last2=Sriranganathan |first2=MK |last3=Edwards |first3=CJ|last4=Buchbinder|first4=R|title=Lifestyle interventions for acute gout |journal=The Cochrane Database of Systematic Reviews|date=4 November 2013 |volume=11 |issue=11 |pages=CD010519 |pmid=24186771 |doi=10.1002/14651858.CD010519.pub2|pmc=9942538 }}</ref> Options for acute treatment include [[nonsteroidal anti-inflammatory drug]]s (NSAIDs), [[colchicine]], and [[glucocorticoid]]s.<ref name=Review08/> While glucocorticoids and NSAIDs work equally well, glucocorticoids may be safer.<ref>{{cite journal|last1=Billy|first1=CA|last2=Lim|first2=RT|last3=Ruospo|first3=M|last4=Palmer|first4=SC|last5=Strippoli|first5=GFM|title=Corticosteroid or Nonsteroidal Antiinflammatory Drugs for the Treatment of Acute Gout: A Systematic Review of Randomized Controlled Trials|journal=The Journal of Rheumatology|volume=45|issue=1|pages=128–136|date=1 August 2017|doi=10.3899/jrheum.170137|pmid=28765243|s2cid=8306526|url=http://www.jrheum.org/content/jrheum/45/1/128.full.pdf|access-date=7 June 2020|archive-date=7 August 2020|archive-url=https://web.archive.org/web/20200807040103/https://www.jrheum.org/content/jrheum/45/1/128.full.pdf|url-status=live}}</ref> Options for prevention include [[allopurinol]], [[febuxostat]], and [[probenecid]]. Lowering uric acid levels can cure the disease.<ref name=Lancet2010/> Treatment of [[comorbidity|associated health problems]] is also important.<ref name=Lancet2010/> Lifestyle interventions have been poorly studied.<ref name=Moi2013/> It is unclear whether dietary supplements have an effect in people with gout.<ref>{{cite journal |last1=Andrés |first1=Mariano |last2=Sivera |first2=Francisca |last3=Buchbinder |first3=Rachelle |last4=Pardo Pardo |first4=Jordi |last5=Carmona |first5=Loreto |title=Dietary supplements for chronic gout |journal=The Cochrane Database of Systematic Reviews |date=12 November 2021 |volume=11 |issue=11 |pages=CD010156 |doi=10.1002/14651858.CD010156.pub3 |doi-access=free|pmid=34767649 |pmc=8589461 |issn=1469-493X}}</ref>

===NSAIDs===
NSAIDs are the usual first-line treatment for gout.<!-- <ref name=Review08/> --> No specific agent is significantly more or less effective than any other.<ref name=Review08/> Improvement may be seen within four hours and treatment is recommended for one to two weeks.<ref name=Lancet2010/><ref name=Review08/> They are not recommended for those with certain other health problems, such as [[gastrointestinal bleeding]], [[kidney failure]], or [[heart failure]].<ref name=JFP09/> While [[indometacin]] has historically been the most commonly used NSAID, an alternative, such as [[ibuprofen]], may be preferred due to its better side effect profile in the absence of superior effectiveness.<ref name=CFP09>{{cite journal |vauthors=Laubscher T, Dumont Z, Regier L, Jensen B |title=Taking the stress out of managing gout |journal=Can Fam Physician |volume=55 |issue=12 |pages=1209–1212 |date=December 2009 |pmid=20008601 |pmc=2793228}}</ref> For those at risk of gastric side effects from NSAIDs, an additional [[proton pump inhibitor]] may be given.<ref>{{cite journal|last1=Cronstein|first1=BN|last2=Terkeltaub|first2=R|title=The inflammatory process of gout and its treatment|journal=Arthritis Research & Therapy|date=2006|volume=8|issue=Suppl 1 |pages=S3|pmid=16820042|doi=10.1186/ar1908|pmc=3226108 |doi-access=free }}</ref> There is some evidence that [[COX-2 inhibitor]]s may work as well as nonselective NSAIDs for acute gout attack with fewer side effects.<ref>{{cite journal|last1=van Durme|first1=CM|last2=Wechalekar|first2=MD|last3=Landewé|first3=RB|title=Nonsteroidal anti-inflammatory drugs for treatment of acute gout|journal=JAMA|date=9 June 2015|volume=313|issue=22|pages=2276–2277|pmid=26057289|doi=10.1001/jama.2015.1881}}</ref><ref name=":1">{{cite journal |last1=van Durme |first1=Caroline Mpg |last2=Wechalekar |first2=Mihir D. |last3=Landewé |first3=Robert Bm |last4=Pardo Pardo |first4=Jordi |last5=Cyril |first5=Sheila |last6=van der Heijde |first6=Désirée |last7=Buchbinder |first7=Rachelle |date=9 December 2021 |title=Non-steroidal anti-inflammatory drugs for acute gout |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=12 |pages=CD010120 |doi=10.1002/14651858.CD010120.pub3 |issn=1469-493X |pmc=8656463 |pmid=34882311}}</ref><ref name=":2">{{Cite journal |last1=Roddy |first1=Edward |last2=Bajpai |first2=Ram |last3=Forrester |first3=Harry |last4=Partington |first4=Richard James |last5=Mallen |first5=Christian D. |last6=Clarson |first6=Lorna Elise |last7=Padmanabhan |first7=Nishita |last8=Whittle |first8=Rebecca |last9=Muller |first9=Sara |date=1 December 2023 |title=Safety of colchicine and NSAID prophylaxis when initiating urate-lowering therapy for gout: propensity score-matched cohort studies in the UK Clinical Practice Research Datalink |url=https://ard.bmj.com/content/82/12/1618 |journal=Annals of the Rheumatic Diseases |language=en |volume=82 |issue=12 |pages=1618–1625 |doi=10.1136/ard-2023-224154 |issn=0003-4967 |pmc=10646835 |pmid=37788904 |access-date=16 February 2024 |archive-date=16 February 2024 |archive-url=https://web.archive.org/web/20240216155634/https://ard.bmj.com/content/82/12/1618 |url-status=live }}</ref><ref name=":3">{{Cite journal |date=6 February 2024 |title=How common are side-effects of treatment to prevent gout flares when starting allopurinol? |url=https://evidence.nihr.ac.uk/alert/how-common-are-side-effects-of-treatment-to-prevent-gout-flares-when-starting-allopurinol/ |journal=NIHR Evidence |doi=10.3310/nihrevidence_62005 |s2cid=267539627 |access-date=16 February 2024 |archive-date=16 February 2024 |archive-url=https://web.archive.org/web/20240216155634/https://evidence.nihr.ac.uk/alert/how-common-are-side-effects-of-treatment-to-prevent-gout-flares-when-starting-allopurinol/ |url-status=live }}</ref>

===Colchicine===
[[Colchicine]] is an alternative for those unable to tolerate NSAIDs.<ref name=Review08/> At high doses, side effects (primarily gastrointestinal upset) limit its usage.<ref name="FDA Warning">{{cite web | title=Information for Healthcare Professionals: New Safety Information for Colchicine (marketed as Colcrys) | url=https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm174315.htm | publisher=[[U.S. Food and Drug Administration]] | url-status=live | archive-url=https://web.archive.org/web/20091018113639/https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm174315.htm | archive-date=18 October 2009 }}</ref> At lower doses, which are still effective, it is well tolerated.<ref name=CFP09/><ref>{{cite journal|vauthors=McKenzie BJ, Wechalekar MD, Johnston RV, Schlesinger N, Buchbinder R|date=26 August 2021|title=Colchicine for acute gout|journal=The Cochrane Database of Systematic Reviews|volume=2021|issue=8|pages=CD006190|doi=10.1002/14651858.CD006190.pub3|pmid=34438469|pmc=8407279}}</ref><ref name=":2" /><ref name=":3" /> Colchicine may interact with other commonly prescribed drugs, such as [[atorvastatin]] and [[erythromycin]], among others.<ref name="FDA Warning" />

===Glucocorticoids===
[[Glucocorticoid]]s have been found to be as effective as NSAIDs<ref name=":1" /><ref name="pmid17276548">{{cite journal |vauthors=Man CY, Cheung IT, Cameron PA, Rainer TH |title=Comparison of oral prednisolone/paracetamol and oral indomethacin/paracetamol combination therapy in the treatment of acute goutlike arthritis: a double-blind, randomized, controlled trial |journal=Annals of Emergency Medicine |volume=49 |issue=5 |pages=670–677 |year=2007 |pmid=17276548 |doi=10.1016/j.annemergmed.2006.11.014 |pmc=7115288 |url=http://orca.cf.ac.uk/92845/1/paracetemol.pdf |access-date=8 September 2019 |archive-date=20 October 2020 |archive-url=https://web.archive.org/web/20201020143558/http://orca.cf.ac.uk/92845/1/paracetemol.pdf |url-status=live }}</ref> and may be used if contraindications exist for NSAIDs.<ref name=Review08/><ref name=":0">{{cite journal|last1=Wechalekar|first1=Mihir D|last2=Vinik|first2=Ophir|last3=Schlesinger|first3=Naomi|last4=Buchbinder|first4=Rachelle|date=30 April 2013|title=Intra-articular glucocorticoids for acute gout|journal=Cochrane Database of Systematic Reviews|issue=4|pages=CD009920|doi=10.1002/14651858.cd009920.pub2|pmid=23633379|issn=1465-1858|pmc=11847606}}</ref> They also lead to improvement when [[Joint injection|injected into the joint]].<ref name=Review08/> A [[septic arthritis|joint infection]] must be excluded, however, as glucocorticoids worsen this condition.<ref name=Review08/> There were no short-term adverse effects reported.<ref>{{cite journal|last1=Janssens|first1=Hein J|last2=Lucassen|first2=Peter LBJ|last3=Van de Laar|first3=Floris A|last4=Janssen|first4=Matthijs|last5=Van de Lisdonk|first5=Eloy H|date=23 April 2008|title=Systemic corticosteroids for acute gout|journal=Cochrane Database of Systematic Reviews|volume=2010|issue=2|pages=CD005521|doi=10.1002/14651858.cd005521.pub2|pmid=18425920|pmc=8276233|issn=1465-1858|url=https://repository.ubn.ru.nl/bitstream/2066/70896/1/70896.pdf|hdl=2066/70896|hdl-access=free|access-date=24 September 2019|archive-date=28 August 2021|archive-url=https://web.archive.org/web/20210828094218/https://repository.ubn.ru.nl/bitstream/handle/2066/70896/70896.pdf;jsessionid=1FC701B94528B3F6C1BBA1E193546020?sequence=1|url-status=live}}</ref>

===Others===
[[Interleukin-1]] inhibitors, such as [[canakinumab]], showed moderate effectiveness for pain relief and reduction of joint swelling, but have increased risk of [[adverse event]]s, such as back pain, headache, and increased blood pressure.<ref name=Siv2014>{{cite journal|pmid=25177840|year=2014|last1=Sivera|first1=F|title=Interleukin-1 inhibitors for acute gout|journal=Cochrane Database of Systematic Reviews|issue=9|pages=CD009993|last2=Wechalekar|first2=M. D|last3=Andrés|first3=M|last4=Buchbinder|first4=R|last5=Carmona|first5=L|volume=2014 |doi=10.1002/14651858.CD009993.pub2|pmc=10891421}}</ref> They, however, may work less well than usual doses of NSAIDS.<ref name=Siv2014/> The high cost of this class of drugs may also discourage their use for treating gout.<ref name=Siv2014/>
{{Further|topic=the investigational new drug|Tigulixostat}}