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              <p>Objectif :Élaborer les recommandations de la Société française de rhumatologie pour la prise en charge des crises de goutte.Méthodes :Ces recommandations ont été élaborées par 9 rhumatologues (hospitaliers ou libéraux), 3 généralistes, 1 cardiologue, 1 néphrologue et 1 patient, sur la base d’une revue systématique de la littérature.Résultats :Quatre principes généraux et 4 recommandations ont été établis. Les principes généraux soulignent l’importance de l’éducation du patient, et du traitement précoce des crises de goutte, si possible dans les 12 premières heures, selon un traitement pré-défini. Les patients doivent savoir que la goutte est une maladie chronique qui nécessite un traitement hypo-uricémiant en sus du traitement de la crise. Les comorbidités et les possibles interactions médicamenteuses, qui peuvent contre-indiquer certains traitements anti-inflammatoires, doivent être recherchées avec soin chez tous les patients. La colchicine doit être prescrite à la dose suivante : 1 mg puis 0,5 mg une heure plus tard, puis 0,5 mg deux à trois fois par jour les jours suivants. La diarrhée est le premier symptôme d’intoxication à la colchicine, et doit faire diminuer les posologies. La posologie de la colchicine doit également être diminuée chez les patients présentant une insuffisance rénale chronique ou prenant des médicaments qui interagissent avec son métabolisme. Les autres options de première ligne sont les corticoïdes (oraux ou intra-articulaires), les anti-inflammatoires non stéroïdiens (AINS). Les anti-IL-1 sont un traitement de seconde ligne, en cas d’échec, intolérance ou contre-indication à la colchicine, aux corticoïdes ou aux AINS. Ils sont contre-indiqués en cas d’infection et doivent faire surveiller les polynucléaires neutrophiles.Conclusion :Ces recommandations proposent des stratégies d’utilisation des anti-inflammatoires pour une meilleure prise en charge des crises de goutte.</p>
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