The provided UK guideline excerpts primarily detail the recommended first-line treatments for managing an acute attack of gout, not pseudogout NICE CKS,NICE NG219. 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 NICE NG219.
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 NICE CKS. A proton pump inhibitor (PPI) should be considered for gastric protection when prescribing an NSAID NICE CKS,NICE NG219.
- Colchicine NICE CKS.
- A short course of an oral corticosteroid, such as prednisolone 30-35 mg once a day for 3-5 days NICE CKS. This is noted as an off-label use of oral corticosteroids NICE CKS,NICE NG219.
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 NICE CKS,NICE NG219. Ice packs can be applied to the affected joint to help alleviate pain in gout NICE CKS,NICE NG219. Combining treatments can be considered if the response to monotherapy is inadequate NICE CKS. Paracetamol may be considered as an adjunct for pain relief in gout NICE CKS. 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 NICE CKS,NICE NG219. People with gout should be advised to rest and elevate the limb, and keep the joint exposed and in a cool environment NICE CKS. They should return if symptoms worsen or if there is no improvement after 1-2 days NICE CKS.