First-line pharmacologic therapy for an acute gout flare?

• A. NSAIDs (e.g., indomethacin)
• B. Allopurinol
• C. Colchicine
• D. Corticosteroids

Answer: (A)

Treating an acute gout flare focuses on rapidly reducing joint inflammation and pain. Nonsteroidal anti-inflammatory drugs are the go-to first-line option because they provide fast, potent anti-inflammatory effects by blocking cyclooxygenase and lowering prostaglandin production, which quickly dampens the inflammatory response to urate crystals. Indomethacin is a classic example that has strong evidence for quick relief in the acute setting. This approach is preferred when there are no contraindications like significant kidney disease or peptic ulcers, and when NSAIDs are tolerated.

Colchicine can be used, but it often has slower onset and more gastrointestinal side effects, making it a less favorable first choice in many cases. Corticosteroids are effective and useful if NSAIDs are not suitable or for patients with multiple joints involved or refractory flares, but they are typically considered after NSAIDs. Allopurinol, an urate-lowering drug, is not used to treat an acute attack because lowering uric acid during a flare can worsen symptoms or prolong the episode and should be started after the flare resolves.