Prophylaxis Treatments
Basics
Prophylaxis means preventative and prophylactic gout treatment is for people who are either starting or have just started urate-lowering therapy (ULT). When ULT is started, people actually have a slightly increased risk of having gout flares for 3-6 months while their uric acid is mobilized and excreted from their body by the kidneys1.
People who have frequent gout flares should NOT be on prophylaxis as their only treatment. Frequent flares are best treated with ULT.
Prophylaxis Treatments
Prophylactic treatments are the same as are used for gout flares, just at lower doses and taken for a longer period of time. The most commonly used prophylactic treatments are:
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NSAIDs: Cheap, available over-the-counter, and generally well-tolerated. They have a long list of relative contraindications that should be considered given the duration of prophylaxis is much longer than treatment of a single gout flare. See the PpxAid page for more information, or just use PpxAid to help you decide.
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Colchicine: Prescription only and more expensive than other options in the US. At the lower doeses used for prophylaxis, it is generally well tolerated. It also has a long list of drug interactions, some of which are serious. It is also contraindicated in patients with severe kidney problems. In other countries it is cheap and readily available.
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Steroids: Prednisone is the most commonly prescribed corticosteroid. It's cheap and makes everything, not just gout, feel better. It has a well-described set of side effects, such as its propensity to raise blood sugar (use cautiously in diabetics) and cause weight gain. It can also cause insomnia, exacerbate anxiety, and cause other mood changes.
References
- Becker MA, Schumacher HR Jr, Wortmann RL, MacDonald PA, Eustace D, Palo WA, Streit J, Joseph-Ridge N. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med. 2005 Dec 8;353(23):2450-61. doi: 10.1056/NEJMoa050373. PMID: 16339094.