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Doctor Patient Gout Pain Partnership
Doctor Patient Gout Pain Partnership

Gout Pain Relief Guideline 2020

In my review of the 2020 gout management guideline, I selected 7 important recommendations. However, I also explained there are 42 recommendations in total. Most importantly, your doctor needs your input as a patient in order to apply those recommendations in ways that help you best.

Gout Pain Relief Intent

In this review, I intend to introduce the guideline recommendations that apply to gout pain relief. That supports the purpose of this website. Because it shows you the key points about relieving gout pain that you must discuss with your health professionals.

In a subsequent review, I will explain the recommendations related to uric acid control. I cover pain relief first. Because most gout patients will require pain relief during the first few months of uric acid treatment. After that, I will review those recommendations relating to lifestyle.

Gout Guideline 2020 Scope

You must understand that, as a guideline, the ACR (American College of Rheumatology) recommends best practices to doctors based on their analysis of relevant gout research. But those recommendations are based on statistical analysis of results that often rely on averages.

In this review, I will introduce those recommendations. Then for each recommendation I will explain some of the important findings from specific research studies. But that is where you need to discuss the details with your doctor. Because your circumstances will help you and your doctor decide how each recommendation applies to you.

Now this seems to suggest that you will need a great deal of discussion time with your health professionals. But many recommendations will not apply to you. Also, many more recommendations have easily agreed options. However, it is important to understand which recommendations apply to you. Then for those recommendations, it is important that you have considered the guideline - even if it is a quick decision. Because you should only ignore some aspects of the guidelines where it is clear that they don't apply to you.

You should realize that the 2020 gout guideline is not a complete guide to gout management. In particular, ACR only make recommendations where they find enough evidence to support their decision. So you might have experiences, or have read studies that are not included in the guideline. In which case, you should agree your pain relief choices with your medical advisers.

Gout Pain Relief Recommendations

The recommendations from the 2020 guideline related to gout pain relief are:

Gout flare management

  1. For patients experiencing a gout flare, we strongly recommend using oral colchicine, NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), or glucocorticoids (oral, intraarticular, or intramuscular) as appropriate first-line therapy for gout flares over IL-1 inhibitors or ACTH (the choice of colchicine, NSAIDs, or glucocorticoids should be made based on patient factors and preferences).
  2. When colchicine is the chosen agent, we strongly recommend low-dose colchicine over high-dose colchicine given its similar efficacy and fewer adverse effects.
  3. For patients experiencing a gout flare for whom other anti-inflammatory therapies are poorly tolerated or contraindicated, we conditionally recommend using IL-1 inhibition over no therapy (beyond supportive/analgesic treatment).
  4. For patients who may receive 'Nothing By Mouth', we strongly recommend glucocorticoids (intramuscular, intravenous, or intraarticular) over IL-1 inhibitors or ACTH.
  5. For patients experiencing a gout flare, we conditionally recommend using topical ice as an additional treatment over no additional treatment.

Gout Pain Relief Best Practice

In the Anti-Inflammatories appendix to the guideline there are comparisons of different classes of pain relieving medicines. For these comparisons, the guideline uses "acetic acid derivatives" as a reference. In most cases, this means indomethacin. Though similar drugs such as sulindac might be prescribed.

  • Canakinumab is probably the most effective for reducing pain at day 2. Intravenous or intramuscular corticosteroids are less effective compared with canakinumab but may be more effective than the other drugs. Rilonacept is likely more effective than the reference (acetic acid derivatives) but inferior to intravenous or intramuscular corticosteroids and canakinumab. All the other drugs might not have different efficacy in terms of pain reduction at day 2.
  • Canakinumab is the only intervention that may be better than the reference (acetic acid derivatives) for reducing pain at the longest follow-up. All the other drugs might not have different efficacy.
  • Canakinumab may be the only intervention that is better than the reference (acetic acid derivatives) for improving joint tenderness at day 2. All the other drugs may not have different efficacy.
  • There may be no differences among the drugs for improving joint tenderness at the longest follow-up.
  • Canakinumab is probably the most effective intervention for improving joint swelling at day 2. Profens the only interventions that are worse than the reference (acetic acid derivatives). There may be no difference among the other drugs for improving joint swelling at day 2.
  • There may be no difference among the drugs for improving joint swelling at the longest follow-up.
  • There may be no difference among the drugs for patient global assessment at day 2.
  • Acetic acid derivatives is probably more effective than profens regarding patient global assessment at longest follow-up.
  • Oral corticosteroids are the only interventions that may cause less serious adverse events than acetic acid derivatives.
  • Anakinra is non-inferior to a free choice of a free choice of colchicine, naproxen, or prednisolone in terms of pain reduction, patient global assessment, joint tenderness, joint swelling at longest follow-up.

Your Best Gout Pain Relief

Always bear in mind the scope of the 2020 gout guideline. Because it exists to recommend best practice for all gout sufferers. But your circumstances might override the best practice for other people. So you should discuss any concerns about the recommendations with health professionals.

The guideline strongly recommends that you choose between low-dose colchicine, NSAIDs, or steroids. According to your preferences and medical history. So if you are not sure which is the best choice for you, discuss that with your doctor.

As you see, there are two special cases where you might be unable to choose any of those. Because they might not be suitable for you. Or you might be unable to take oral medicine. Finally, the guideline suggests that the best aditional treatment is to apply ice to your swollen joints. However, you should discuss the issues I raise in Heat Or Ice For Gout Relief with your doctor.

Finally, do you have any questions, experiences, or opinions about guidelines for gout pain relief? First, check to see if we are already discussing your concerns in the Gout Forum.

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