When Should I Seek Medical Attention for a Gout Flare?

Medical Attention for a Gout Flare

If you have gout and suffer with gout attacks, when is the right time to seek medical attention for a gout flare? You may have learned (through trial and error, perhaps) what to do to get through the initial pain of a gout attack. Many people who have the condition follow one or more of these steps to get relief from gout flares1:

  • Take an over the counter NSAID (not aspirin, though, as aspirin can make a gout flare worse)
  • Apply ice or a cold pack
  • Drink lots of water
  • Rest and/or elevate the joint in a comfortable position
  • Try to relax
  • Avoid the foods and drinks that can trigger a flare or make it worse (eg, red meat, shellfish, alcoholic beverages)

But what if you’re having unusual symptoms, like fever or back pain? When should you seek medical attention for gout flares that are becoming more frequent and/or severe?

 

Seek medical attention for a gout flare if you are running a fever

What’s worse than a gout flare? Having a gout flare and a fever. If you run a fever during a gout attack, call your doctor right away.2 Although fever does occasionally accompany gout flares (especially in older patients2), it can be a sign of septic arthritis, which is a serious infection in a joint3. This kind of infection can start when germs travel through the bloodstream from another part of the body to the affected area.3 Septic arthritis is most common in the knee but can affect other parts of the body as well, including the hips, shoulders and other joints.3 These infections are especially dangerous because they can quickly and severely damage cartilage and bone.3 Be sure to contact your doctor and seek treatment right away if you are having gout flare symptoms and running a fever at the same time.3

 

Seek medical attention for a gout flare if you have lower back pain

In most people with gout, flares tend to occur in the big toe or other extremities first.4 However, gout does not affect everyone in exactly the same way.4 If you have consistently high uric acid levels and you’ve recently had unexplained back or neck pain, numbness or tingling sensations down your arm or leg, there is a small chance it could be gout.4 Though gout in the spine is very unusual, Theodore Fields, MD, a rheumatologist in The Hospital for Special Surgery in New York City, says it is more common than many people might think.4 According to Dr. Fields, “Gout can travel to almost any joint over time.”4 So if you have back pain and a history of gout, talk with your doctor.4

 

Seek medical for a gout flare if your gout flares are becoming more frequent and/or severe

In the early stages of gout, the sudden and intense pain and inflammation that accompanies gout attacks typically lasts only a day or two.5 During the periods between gout flares, the joints feel fairly normal and function as they are supposed to.5 If your gout goes untreated over a period of several years, however, you may begin to experience flares more frequently.5 Even more concerning, your gout flares may become increasingly severe, longer-lasting and involve multiple joints.5 All of these symptoms are your body’s way of telling you that your gout is becoming more serious.5

 

Medication may help prevent gout attacks6

If you are experiencing several gout flares each year or if your gout attacks are increasingly painful, make an appointment to see your doctor.6,7 Your doctor can help you manage the condition and maintain your health. If you are not yet taking a urate-lowering treatment (ULT), your doctor may have you start one.6,7 And whether you’re new to ULT or have been taking it for years, be sure to ask your doctor about adding a colchicine therapy.8,9 Adding colchicine (eg, Mitigare® (Colchicine) 0.6mg Capsules or Generic Colchicine 0.6mg Capsules) to your regimen may help reduce the frequency and severity of your gout attacks.8-10 to your regimen may help reduce the frequency and severity of your gout attacks.8-10 For more information about colchicine and how it can prevent gout attacks, click here.10

 

Mitigare® is a registered trademark of Hikma Pharmaceuticals USA Inc.

 

Colchicine 0.6mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.

Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.

Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia and aplastic anemia have been reported with colchicine used in therapeutic doses.

Monitor for toxicity and, if present, consider temporary interruption or discontinuation of colchicine.

Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death.

Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this effect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of Mitigare®.

The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting and abdominal pain.

 

Please see the full Prescribing Information and Medication Guide for Mitigare® for complete product details.

 

NOTE: This article was not written by a medical professional and is not intended to substitute for the guidance of a physician. These are not Hikma’s recommendations for gout flare prevention, but rather facts and data collected from various reliable medical sources. For a full list of resources and their attributing links, see below.

References

  1. Managing a Gout Flare. Arthritis Foundation website. Available at: https://www.arthritis.org/diseases/more-about/managing-a-gout-attack Accessed February 1, 2021.
  2. Lee JH, Yang JA, Shin K, et al. Elderly Patients Exhibit Stronger Inflammatory Responses During Gout Attacks. J Korean Med Sci. 2017;32(12):1967–1973.
  3. Septic Arthritis. Mayo Clinic website. Available at: https://www.mayoclinic.org/diseases-conditions/bone-and-joint-infections/symptoms-causes/syc-20350755. Accessed February 1, 2021.
  4. Could Your Back Pain Be Gout? Arthritis Foundation website. Available at: http://blog.arthritis.org/gout/back-pain-spinal-gout/. Accessed February 1, 2021.
  5. Gout Symptoms. Gout Education Society website. Available at: https://gouteducation.org/what-is-gout/symptoms/. Accessed February 1, 2021.
  6. Gout/Diagnosis & treatment. Mayo Clinic website. Available at: https://www.mayoclinic.org/diseases-conditions/gout/diagnosis-treatment/drc-20372903. Accessed February 1, 2021.
  7. Why Is My Gout Not Getting Better? Arthritis Foundation website. Available at: https://www.arthritis.org/diseases/more-about/why-is-my-gout-not-getting-better. Accessed February 1, 2021.
  8. Borstad GC, Bryant LR, Abel MP, Scroggie DA, Harris MD, Alloway JA. Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis. J Rheumatol. 2004;31:2429–2432.
  9. Yu TF, Gutman AB. Efficacy of colchicine prophylaxis in gout. Prevention of recurrent gouty arthritis over a mean period of five years in 208 gouty subjects. Ann Intern Med. 1961;55:179–192.
  10. Mitigare® (Colchicine) 0.6mg Capsules [prescribing information]. Columbus, OH: West-Ward Columbus, Inc.; 2019.

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.
  • Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.
  • Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, and aplastic anemia have been reported with colchicine used in therapeutic doses.
  • Monitor for toxicity and if present consider temporary interruption or discontinuation of colchicine.
  • Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death.
  • Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this effect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of Mitigare®.
  • The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal pain.

Indication

Mitigare® is indicated for prophylaxis of gout flares in adults. The safety and effectiveness of Mitigare for acute treatment of gout flares during prophylaxis has not been studied.

Mitigare® is not an analgesic medication and should not be used to treat pain from other causes.

For Full Prescribing Information please CLICK HERE and for Medication Guide CLICK HERE.

You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Manufactured by: West-Ward Columbus Inc., Columbus, OH 43228

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4.