Selecting drugs in acute gout

What should guide our decisions when selecting drugs used in the treatment of acute gout?

George Nuki: Particularly thinking about the contraindications and comorbidities, which might exclude the use, for instance, of a nonsteroidal drug or colchicine if the patients are taking a drug in addition that might have a drug interaction. There has been one recent trial, not yet published but presented at the British Society for Rheumatology meetings in Birmingham a month ago [the CONTACT trial discussed at Rheumatology 2017 in April 2017], which was the first large-scale randomized controlled trial comparing—in general practice, in the community—colchicine with a nonsteroidal anti-inflammatory drug; it was naproxen. The result of that trial suggested that there were some advantages in terms of both risks and benefits for using nonsteroidal anti-inflammatory drugs. On the other hand, there are some even more recent data suggesting that even short-term use of nonsteroidal anti-inflammatory drugs carries some increased cardiovascular risk, for example.

At the moment, one cannot be absolutely dogmatic about which is most effective. If you have doubts or there are contraindications for using colchicine and nonsteroidal anti-inflammatory drugs, steroids can be very effective. As I said before, if you have the experience and the opportunity to do it, a single intra-articular injection can be very, very effective. And for rheumatologists and rheumatological trainees or physician trainees, I would say that is something that they should become experienced in doing.