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🌱 來自: gout

Table-Acute Treatment for Gout

Drug	Initial Dose
NSAIDs (nonsel or COX-2 inhib)	Full anti-inflammatory dose → tapering
Colchicine (PO; IV no longer available in U.S.)	1.2 mg then → 0.6 mg 1 h later → 0.6 mg bid
Corticosteroids (PO, IA, IV, IM)	eg, prednisone 0.5 mg/kg/d × 5-10 d ± taper
ACTH (IM)	eg, 100 IU IM ×1-2 doses
IL-1 inhibitors	anakinra (100 mg SC qd × 3 d); canakinumab (150 mg SC × 1)

Apologies for that. Here are the first and third columns:

Drug	Comments
NSAIDs (nonsel or COX-2 inhib)	Gastritis & GIB risk. Avoid in CKD & CVD. ≈ efficacy among NSAIDs.
Colchicine (PO; IV no longer available in U.S.)	N/V/diarrhea (w/ ↑ dose), marrow suppression, myopathy, neuropathy. ↓ dose in CKD (however, not nephrotoxic).
Corticosteroids (PO, IA, IV, IM)	Rule out joint infection 1st. Corticosteroid injection if <3 joints.
ACTH (IM)	↑ cost, ↓ s/e, limited data (Semin Arthritis Rheum 2014;43:648)
IL-1 inhibitors	↑↑ cost; anakinra a/w injection site pain

• IL-1 inhibitors: Canakinumab approved in EU (Ann Rheum Dis 2012;71:1839; Arth Rheum 2010;62:3064)