Gout is the most common cause of inflamed joints affecting 1.4% of adults in the UK. Most
patients are treated entirely in general practice yet primary care management is frequently
suboptimal. Acute attacks of gout are excruciatingly painful and require urgent drug
treatment to reduce inflammation, most commonly with antiinflammatory drugs(NSAIDs) or
colchicine. In primary care, NSAIDs are most commonly used but can cause serious side effects
such as stomach ulcers and heart disease, particularly in the elderly. Patients frequently
require repeat prescriptions for recurrent attacks of acute gout increasing the risk of
drug-related side-effects. Low-dose colchicine is popular amongst rheumatologists as it is
effective and well tolerated. However, general practitioners (GPs) prescribe colchicine
infrequently, probably because in the past the recommendation was for high doses to be
prescribed which commonly caused severe diarrhoea. Recently, prescribing recommendations for
colchicine have changed, advocating a lower dose regime.
Currently there is no evidence regarding whether NSAIDs or low-dose colchicine is the best
treatment for acute gout. This trial will be the first direct comparison of the effectiveness
and side effects of a NSAID (naproxen) and low-dose colchicine to treat acute gout in primary
care. Naproxen will be used in this trial because it has been shown to be as effective as
oral prednisolone for the treatment of acute gout, is safer than other commonly used NSAIDs
such as diclofenac and indomethacin, and is inexpensive.
Patients consulting their GP with an acute attack of gout in up to 100 general practices will
be invited to participate. Treatment success will be assessed by comparing pain reduction
between the two drugs. The trial will also monitor side effects, quality of life, and cost
effectiveness.