title: Treatment of acute gout: a systematic review.
abstract: OBJECTIVE
  Acute gout is traditionally treated with NSAIDs, corticosteroids, and colchicine; however, subjects have multiple comorbidities that limit the use of some conventional therapies. We systematically reviewed the published data on the pharmacologic and non-pharmacologic agents used for the treatment of acute gouty arthritis.
  
  
  METHODS
  A systematic search was performed using PubMed and Cochrane database through May 2013. We included only randomized controlled trials (RCTs) that included NSAIDs, corticosteroids, colchicine, adrenocorticotropic hormone (ACTH), interleukin-1 (IL-1) inhibitors, topical ice, or herbal supplements.
  
  
  RESULTS
  Thirty articles were selected for systematic review. The results show that NSAIDs and COX-2 inhibitors are effective agents for the treatment of acute gout attacks. Systemic corticosteroids have similar efficacy to therapeutic doses of NSAIDs, with studies supporting oral and intramuscular use. ACTH is suggested to be efficacious in acute gout. Oral colchicine demonstrated to be effective, with low-dose colchicine demonstrating a comparable tolerability profile as placebo and a significantly lower side effect profile to high-dose colchicine. The IL-1β inhibitory antibody, canakinumab, was effective for the treatment of acute attacks in subjects refractory to and in those with contraindications to NSAIDs and/or colchicine. However, rilonacept was demonstrated to be not as effective, and there are no RCTs for the use of anakinra.
  
  
  CONCLUSIONS
  NSAIDs, COX-2 selective inhibitors, corticosteroids, colchicine, ACTH, and canakinumab have evidence to suggest efficacy in treatment of acute gout.
authors.affiliation: Division of Rheumatology, University of Michigan, 300 North Ingalls, 7D13, Ann Arbor, MI 48109-5422. Electronic address: pkhanna@umich.edu.
authors.forename: Puja P
authors.initials: PP
authors.lastname: Khanna
authors.affiliation: Emory University, Atlanta, GA.
authors.forename: Heather S
authors.initials: HS
authors.lastname: Gladue
authors.affiliation: Rochester General Health System, Rochester, NY.
authors.forename: Manjit K
authors.initials: MK
authors.lastname: Singh
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA.
authors.forename: John D
authors.initials: JD
authors.lastname: FitzGerald
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA.
authors.forename: Sangmee
authors.initials: S
authors.lastname: Bae
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA.
authors.forename: Shraddha
authors.initials: S
authors.lastname: Prakash
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA.
authors.forename: Marian
authors.initials: M
authors.lastname: Kaldas
authors.affiliation: David Geffen School of Medicine, UCLA, Los Angeles, CA.
authors.forename: Maneesh
authors.initials: M
authors.lastname: Gogia
authors.affiliation: Division of Rheumatology, University of Michigan, 300 North Ingalls, 7D13, Ann Arbor, MI 48109-5422.
authors.forename: Veronica
authors.initials: V
authors.lastname: Berrocal
authors.affiliation: Division of Rheumatology, University of Michigan, 300 North Ingalls, 7D13, Ann Arbor, MI 48109-5422; Taubman Health Science Library, University of Michigan, 300 North Ingalls, 7D13, Ann Arbor, MI 48109-5422.
authors.forename: Whitney
authors.initials: W
authors.lastname: Townsend
authors.affiliation: VAMC/UCSD, La Jolla, CA.
authors.forename: Robert
authors.initials: R
authors.lastname: Terkeltaub
authors.affiliation: Division of Rheumatology, University of Michigan, 300 North Ingalls, 7D13, Ann Arbor, MI 48109-5422.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Khanna
mesh_terms: D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015210:Arthritis, Gouty / Q000188:drug therapy*; D003078:Colchicine / Q000627:therapeutic use; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use; D006073:Gout / Q000188:drug therapy*; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D033461:Hyperuricemia / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D006074:Gout Suppressants; D003078:Colchicine
keywords: Acute gout; Systematic review