Table 3. Treatment options for acute gout.

Substance/group	Proposed therapy	Adverse drug effects	Major contraindications	Recommendation grade	Comments
Nonsteroidal antiinflammatory drugs (NSAIDs) PO	Maximum dose; 5 to 10 days or until symptoms resolve	Renal dysfunction	Renal failure	(A) Cochrane review: NSAID treatment option for acute gout flare (19)	Early start of treatment more important than choice of NSAID
Corticosteroids PO	30 to 35 mg prednisolone PO for 5 days	Overproduction of stomach acid, Cushing’s syndrome, metabolism disorder, hypertension/hypotension	– Infection in particular – Poorly managed diabetes mellitus or arterial hypertension – Ulcerating wound(s)	(A) RCT: Corticosteroids have no disadvantages versus NSAIDs (20)
Colchicine PO	Low-dose therapy: 2 × 0.5 mg initially, then single administration 0.5 mg after 1 hour	Gastrointestinal effects in particular	Reduced creatinine clearance or liver failure; concomitant administration of CYP3A4 inhibitors, e.g. statins (5, 21)	(A) RCT: Low-dose therapy has the same clinical effect as higher dose and fewer adverse effects (22)	If gout flare was no longer than 24 hours ago
Cortisone IA or IM		Overproduction of stomach acid, Cushing’s syndrome, metabolism disorder, hypertension/hypotension		(B) Cochrane review: no evidence to date of clinically significant superiority over oral corticosteroid therapy (23)	IM or IA corticosteroid injection possible in exceptional cases
Interleukin-1 antagonistsCanakinumab SC	Single administration (150 mg SC), repeat administration after no less than 12 weeks (24)	Infections (e.g. urinary tract infections, airway infections); local skin reactions at site of injection	If active infections present	(B) Cochrane review: more effective than 40 mg triamcinolone IM (24)	If all 3 standard treatment options contrain‧dicated/not tolerated

IA: Intra-articular; IM: Intramuscular; NSAID: Nonsteroidal anti-inflammatory drug; PO: Per os; SC: subcutaneous; RCT: Randomized controlled trial