Gout is caused by deposition of monosodium urate crystals in joints (most often the first metatarsophalangeal joint — “podagra”) and soft tissues, secondary to chronic hyperuricaemia. Modern management has two parallel goals: (1) abort the acute flare with anti-inflammatory treatment, and (2) reduce serum uric acid to below 360 µmol/L (300 µmol/L in tophaceous gout) with long-term urate-lowering therapy. The MedsBase Gout Treatment catalogue carries both arms, supplied by WHO-GMP gecertificeerde fabrikanten.
Acute flare — anti-inflammatory treatment. Three options work, choice based on contraindications. NSAIDs (high-dose for 5–7 days) are first-line in patients without renal impairment, peptic ulcer, heart failure, or anticoagulant therapy. Naproxen 500 mg BID, indomethacin 50 mg TID (the historical “gold standard” for acute gout), and ibuprofen 800 mg TID are common choices. We stock Brufen (ibuprofen), Inmecin-R (indomethacin SR), Indicid-75 SR, en Indoga (indomethacin). Colchicine 1.2 mg orally followed by 0.6 mg one hour later (then 0.6 mg BID for 2–3 days) is the alternative — particularly useful when NSAIDs are contraindicated. Stocked as Goutnil (colchicine 0.5 mg). Watch for diarrhoea (dose-related) and avoid in significant renal or hepatic impairment. Oral corticosteroids (prednisolone 30–40 mg daily for 5 days) are the third option when both NSAIDs and colchicine are contraindicated — see Pain Relief Medication category.
Urate-lowering therapy — for chronic management. Indications: ≥ 2 flares per year, tophaceous gout, urate nephrolithiasis, or chronic kidney disease stage ≥ 3 with hyperuricaemia. Allopurinol (xanthine oxidase inhibitor) is first-line — start 100 mg daily (50 mg in CKD), titrate up by 100 mg every 2–4 weeks targeting serum urate < 360 µmol/L. Most patients need 300–600 mg daily. Stocked as Zyrik (allopurinol). HLA-B*5801 testing recommended in Han Chinese, Korean, and Thai populations before starting (severe cutaneous adverse reaction risk). Febuxostat (alternative xanthine oxidase inhibitor — useful when allopurinol-intolerant or insufficient) is stocked as Hyloric. CARES trial flagged a cardiovascular mortality signal — review cardiovascular risk before switching from allopurinol. Probenecid (uricosuric — increases renal urate excretion) as Bencid. Useful in under-excretors with eGFR > 50; contraindicated in urolithiasis history.
Flare prophylaxis during urate-lowering initiation. Starting urate-lowering therapy can mobilise tophi and trigger flares for 6 months. Prophylactic colchicine 0.5 mg once or twice daily for the first 6 months (or NSAID prophylaxis) reduces flare incidence — discontinue once urate is at target and no flares for 3–6 months.
Hoe te kiezen. First flare with no risk factors → NSAID 5–7 days, no urate-lowering yet. Recurrent flares (≥ 2/year) → start allopurinol 100 mg daily with titration + colchicine prophylaxis. Allopurinol failure or intolerance → febuxostat (review cardiovascular risk). Under-excretor (24-hour urinary urate < 600 mg) with no urolithiasis → consider probenecid as alternative or add-on. Tophaceous gout, refractory disease, or pegloticase indication → rheumatology referral.
Belangrijk. Lifestyle measures matter: reduce alcohol (especially beer), reduce fructose-sweetened drinks, weight loss, hydration, low-purine diet, vitamin C 500 mg daily, dairy intake. Continue urate-lowering therapy through acute flares — stopping precipitates further flares. Avoid loop and thiazide diuretics where possible (raise urate). Aspirin 75–100 mg has minor effect; cardiovascular indication usually outweighs urate concern. Acute monoarthritis with fever needs joint aspiration to exclude septic arthritis — gout can mimic but cannot be assumed.
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