Table 2. Acute gout management: first choice drug(s) to treat an acute gouty attack in different scenarios (N = 309).
| Gout attack | Monoarticular | Polyarticular | ||||||
|---|---|---|---|---|---|---|---|---|
| Symptoms’ onset | <36 hours | >36 hours | <36 hours | >36 hours | ||||
| Health status | Healthy 1 | CKD 2 | Healthy | CKD | Healthy | CKD | Healthy | CKD |
| Scenario | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
| Medication | % (CI 95%) | % (CI 95%) | % (CI 95%) | % (CI 95%) | % (CI 95%) | % (CI 95%) | % (CI 95%) | % (CI 95%) |
| High colchicine 3 | 5.2 (2.7–7.7) | 2.9 (1.0–4.8) | 1.6 (0.2–3.0) | 2.3 (0.6–3.9) | 2.3 (0.6–3.9) | 1.9 (0.4–3.5) | 0.0 | 1.3 (0.0–2.6) |
| Low colchicine 4 | 16.5 (12.3–20.7) | 23.0 (18.3–27.7) | 6.8 (4.0–9.6) | 12.3 (8.6–16.0) | 3.2 (1.3–5.2) | 8.7 (5.6–11.9) | 3.2 (1.3–5.2) | 6.5 (3.7–9.2) |
| NSAID | 22.3 (17.7–27.0) | 1.0 (0.0–2.1) | 22.3 (17.7–27.0) | 1.9 (0.4–3.5) | 15.5 (11.5–19.6) | 1.0 (0.0–2.1) | 13.9 (10.0–17.8) | 1.0 (0.0–2.1) |
| PO steroid | 0.3 (0.0–1.0) | 15.9 (11.8–20.0) | 0.6 (0.0–1.5) | 18.8 (14.4–23.1) | 2.3 (0.6–3.9) | 25.2 (20.4–30.1) | 2.9 (1.0–4.8) | 25.9 (21.0–30.8) |
| IM steroid | 1.0 (0.0–2.1) | 7.8 (4.8–10.8) | 1.9 (0.4–3.5) | 8.1 (5.0–11.1) | 3.6 (1.5–5.6) | 14.6 (10.6–18.5) | 3.6 (1.5–5.6) | 14.2 (10.3–18.2) |
| IA steroid | 2.3 (0.6–3.9) | 18.1 (13.8–22.4) | 3.9 (1.7–6.0) | 17.5 (13.2–21.7) | 0.0 | 0.3 (0.0–1.0) | 0.0 | 1.0 (0.0–2.1) |
| NSAID + colchicine | 46.3 (40.7–51.9) | 2.6 (0.8–4.4) | 46.9 (41.3–52.5) | 2.3 (0.66–3.9) | 51.5 (45.9–57.1) | 1.0 (0.0–2.1) | 38.5 (33.1–44.0) | 1.0 (0.0–2.1) |
| NSAID + steroid (PO/IM/IA) | 1.9 (0.4–3.5) | 1.3 (0.0–2.6) | 6.8 (4.0–9.6) | 1.3 (0.0–2.6) | 6.8 (4.0–9.6) | 1.6 (0.2–3.0) | 14.2 (10.3–18.2) | 1.6 (0.2–3.0) |
| Steroid (PO/IM/IA) + colchicine | 4.2 (2.0–6.5) | 27.5 (22.5–32.5) | 9.1 (5.8–12.3) | 35.6 (30.2–41.0) | 14.9 (10.9–18.9) | 45.6 (40.0–51.2) | 23.6 (18.9–28.4) | 47.6 (42.0–53.2) |
1Healthy besides gout
2chronic kidney disease, defined here as creatinine clearance ≤60 ml/min
3colchicine 0.5 mg/hour until symptom resolution or side effect
4colchicine ≤2 mg/day. CI: confidence interval
NSAID: nonsteroidal anti-inflammatory drug; PO: per os; IM: intramuscular; IA: intra-articular.