What is the first-line treatment choice for an acute gout flare?

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An acute gout flare is driven by inflammation from urate crystals in a joint, and the immediate goal is swift pain relief and reduction of swelling. Nonsteroidal anti-inflammatory drugs work by inhibiting prostaglandin production, rapidly dampening the inflammatory response. Indomethacin is a potent NSAID with a fast onset of action, making it the classic first-line choice to quickly control the acute symptoms of a gout attack.

Colchicine is an option when NSAIDs are not suitable or if started very early in the course, but it commonly causes gastrointestinal side effects and may take longer to work. Allopurinol and probenecid are urate-lowering therapies; they don’t address the inflammation of the current flare and can even precipitate or worsen symptoms if started during an attack, so they are reserved for preventing future flares after the acute phase has settled.