Flare Treatments
Basics
The symptoms of gout flares are due to inflammation. Thus, the treatments for gout flares are anti-inflammatory medications. The important thing to know about flare treatments it that they only reduce the severity and duration of symptoms. They do NOT make the symptoms immediately go away and they do NOT treat the underlying cause of gout, which is high uric acid levels, and as such they don't prevent future flares. For that you need ULT.
Flare Treatments
-NSAIDs: Cheap, available over-the-counter, and generally well-tolerated. However, they should be used cautiously in patients who have cardiovascular diseases or any of a relatively long and hard-to-remember list of relative contraindications, even if for a short duration. See the FlareAid page for more information, or just use FlareAid to help you decide.
-Colchicine: Should be cheap, but in the US it's not and is prescription only. It is effective, particularly if started within the first 36 hours of gout flare symptom onset. It is generally well-tolerated. However, it can cause diarrhea and other gastrointestinal symptoms, particularly when used at higher doses for gout flares. It also has a long list of drug interactions, some of which are serious. It is also contraindicated in patients with severe kidney problems. Interestingly, in other countries it is cheap and readily available.
-Steroids: Prednisone is cheap but also prescription only in the US. It is sort of last resort because of the well-described side effects of corticosteroids, but is used all the time for gout flares. It can raise blood sugar, cause weight gain, and increase the risk of infections. It can also cause mood changes and insomnia. It's also not a great choice for patients with diabetes, but winds up being used in this circumstance not uncommonly due to lack of other options.
How Flare Treatments Work
NSAIDs, steroids, and colchicine all work by reducing inflammation. The mechanisms by which they do this are different, but the end result is the same.
Bad Flares
Some gout flares are particularly severe. In these cases, it is often necessary to use medication doses higher than that which Gouthelper typically recommends. We sometimes also use combinations of medications. These are typically done under the supervision of a physician, usually a rheumatologist. Injections of corticosteroids directly into the joint can also be performed, this is also done by a physician.
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