Patient handout

Gout (acute flare → urate-lowering therapy)

PRODUCTION

1. Your condition

This handout is for gout (acute flare → urate-lowering therapy). Your care team identified this based on: acute monoarthritis, often 1st mtp (podagra) (acr 2020 fitzgerald; eular 2024).

Other reasons your team may use this plan: polyarticular flare with prior gout (acr 2020 fitzgerald); hyperuricemia + recurrent flares / tophi / urolithiasis (acr 2020 fitzgerald); tophi on exam / dual-energy ct (eular 2024).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
colchicine	—	—	—	1.2 mg → 0.6 mg 1h later — low-dose colchicine per AGREE trial (Terkeltaub Arthritis Rheum 2010); ACR 2020 FitzGerald strong; 0.6 mg q12h or daily until resolution
naproxen	—	—	—	500 mg BID × 5-7 d; alternative indomethacin 50 mg TID (ACR 2020 FitzGerald first-line)
prednisone	—	—	—	40 mg/d × 5 d or 0.5 mg/kg/d taper over 10-14 d (ACR 2020 FitzGerald first-line; EULAR 2024)
anakinra	—	—	—	100 mg SC daily × 3-5 d (off-label, ACR 2020 FitzGerald conditional; EULAR 2024)

Plan: Acute gout flare (≤24 h symptom onset)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Stable, on ULT, at target SUA

If you have:

No flares in last 6+ months (ACR 2020 FitzGerald)
SUA <6 (or <5 if tophaceous) (ACR 2020 FitzGerald; EULAR 2024)
Taking allopurinol/febuxostat as prescribed

Do this:

Take ULT every day — never stop because you feel well (ACR 2020 FitzGerald strong)
Keep follow-up labs every 6 months (ACR 2020 FitzGerald)
Hydrate, limit alcohol and high-fructose drinks (EULAR 2024)
Discuss any new medications with your prescriber (some raise SUA) (EULAR 2024)
Continue flare prophylaxis (colchicine 0.6 mg daily or NSAID) for at least 6 months after target (ACR 2020 FitzGerald strong)

YELLOW — Early flare or rising SUA

If you have:

New joint pain / warmth / swelling
SUA rising
Missed ULT doses

Do this:

DO NOT stop your ULT during a flare (ACR 2020 FitzGerald strong)
Start your pre-prescribed flare rescue regimen immediately (colchicine 1.2 mg → 0.6 mg 1 h later, then 0.6 mg q12h; OR NSAID if no CKD; OR prednisone if you have a script) (ACR 2020 FitzGerald)
Ice and rest the joint (EULAR 2024)
Call your provider within 24 h if not improving
Continue flare medication until pain fully resolved (typically 5-7 days) (ACR 2020)

Call your provider if:

Flare not improving within 48 h
Multiple joints involved
Fever (ACR 2020 — rule out septic arthritis)

RED — Septic arthritis suspicion or severe systemic illness

If you have:

Fever (>38 C) with hot, swollen joint (ACR 2020 FitzGerald; EULAR 2024)
Single joint that is rapidly worsening
Cannot bear weight or move joint at all
Severe systemic illness

Do this:

Go to emergency department now
Bring medication list including ULT and flare regimen
Tell ED about your gout history but emphasise this might be infection (ACR 2020)

Call your provider if:

Always seek emergency care for fever + joint or severe rapid worsening (ACR 2020; EULAR 2024)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Monoarticular flare with fever, immunocompromise, or atypical features (ACR 2020 FitzGerald; EULAR 2024)(life-threatening)
Visible tophus, joint destruction, or recurrent flares despite ULT (ACR 2020 FitzGerald)
SE Asian or African American ancestry, CKD ≥3, or thiazide use → high AHS risk (ACR 2020 FitzGerald strong)

5. Follow-up

Lifelong ULT for established gout (ACR 2020 FitzGerald strong); CV risk modification; counsel on diet (alcohol, fructose, organ meats), weight, hydration (EULAR 2024); tophus-specific surgery referral if functional impairment

6. Sources

Guideline: 2020 ACR Guideline for Gout (FitzGerald et al, Arthritis Care Res 2020) + 2024 EULAR Updated Recommendations (Richette et al) + ACP 2017