What are the recommended first-line treatments for managing an acute attack of pseudogout in primary care?

The provided UK guideline excerpts primarily detail the recommended first-line treatments for managing an acute attack of gout, not pseudogout ¹,². While calcium pyrophosphate crystal deposition (pseudogout) is mentioned as a condition to assess when diagnosing a painful, red, swollen joint, the guidelines do not specify first-line treatments for pseudogout itself ².

For an acute attack of gout, the recommended first-line treatments, taking into account the person's preferences, comorbidities, and concurrent medication, include:

• A nonsteroidal anti-inflammatory drug (NSAID) at the maximum dose, continued until 1-2 days after the attack has resolved ¹. A proton pump inhibitor (PPI) should be considered for gastric protection when prescribing an NSAID ¹,².
• Colchicine ¹.
• A short course of an oral corticosteroid, such as prednisolone 30-35 mg once a day for 3-5 days ¹. This is noted as an off-label use of oral corticosteroids ¹,².

If NSAIDs and colchicine are not tolerated or are ineffective for gout, an intra-articular or intramuscular corticosteroid injection may be considered, which is also an off-label use ¹,². Ice packs can be applied to the affected joint to help alleviate pain in gout ¹,². Combining treatments can be considered if the response to monotherapy is inadequate ¹. Paracetamol may be considered as an adjunct for pain relief in gout ¹. Interleukin-1 (IL-1) inhibitors are not offered for a gout flare unless NSAIDs, colchicine, and corticosteroids are contraindicated, not tolerated, or ineffective, and referral to rheumatology is required before prescribing ¹,². People with gout should be advised to rest and elevate the limb, and keep the joint exposed and in a cool environment ¹. They should return if symptoms worsen or if there is no improvement after 1-2 days ¹.