Treatment is directed to relieve pain and inflammation
NSAIDs, steroids and narcotics are the mainstays of treatment. All 3 should be used in combination.
Aspirin should be avoided as it may increase uric acid levels
Note: not in prevention doses (81mg) in treatment doses (325-650mg q4h)
NSAIDs and steroids take time to be effective. Provide appropriate analgesia with oral narcotic medication for short term relief
Don't forget the benefit of splinting a "hot" joint (the ankle or wrist for example)
NSAIDs: Use may be limited in the elderly and in those on coumadin or with peptic ulcer disease. 5-7 days of treatment is usually sufficient. Indomethacin is most commonly used (50 mg TID, which may be tapered to 25 mg TID after 3 days)
Steroids: Likely more effective than NSAIDs. Oral prednisolone is more effective than naproxen (1).Use prednisone 30-50 mg for 3-5 days without tapering (as we use for asthma). May be useful to supplement with NSAIDs on the tail end to prevent a rebound flare.If tapping the joint consider intraarticular steroids. If there is concern for medical noncompliance with oral steroids consider IM steroids (triamcinolone 60mg or methylprednisolone).
