For the management of acute
gouty arthritis, non-steroidal anti-inflammatory drugs (
NSAIDs) are the drugs of choice. In recent years, the use of
colchicine has declined because of its frequent adverse reactions, and its reduced efficacy when administered more than 24 hours after onset of an acute attack. Intra-articular
corticosteroid therapy (e.g.
methylprednisolone acetate) is indicated for the treatment of acute mono or oligoarticular
gouty arthritis in aged patients, and in those with co-morbid conditions contraindicating
therapy with either
NSAIDs or
colchicine. Oral
corticosteroids (e.g.
prednisone), and both parenteral
corticotrophin (
ACTH) and
corticosteroids (e.g. intramuscular
triamcinolone acetonide) are valuable, relatively safe alternate treatment modalities in those with polyarticular attacks. For the treatment of hyperuricaemia and chronic
gouty arthritis,
allopurinol is the preferred
urate-lowering
drug. Its toxicity in elderly individuals, those with renal impairment, and in
cyclosporine-treated transplant patients can be minimised by adjusting the initial dose according to the patient's
creatinine clearance. In those experiencing cutaneous reactions to
allopurinol, cautious desensitisation to the
drug can be achieved using a schedule of gradually increasing doses. The therapeutic usefulness of uricosuric drugs is limited by the presence of renal impairment, occurrence of intolerable side-effects, or concomitant intake of
salicylates. They are particularly indicated in patients allergic to
allopurinol and in those with massive tophi requiring combined
therapy with both
allopurinol and a uricosuric.