Many patients treat acute gout flares with over-the-counter pain relievers like ibuprofen or try to push through symptoms without realizing there are effective prescription options for acute flares and chronic urate-lowering therapies that can help prevent recurrent, increasingly frequent attacks that eventually cause permanent joint damage and tophi (uric acid crystal deposits).^1,2 We provide comprehensive management addressing both acute symptom relief and long-term prevention.^1,2

Acute flare management: colchicine, prescription strength NSAIDs (indomethacin, naproxen), or corticosteroids (prednisone, including for patients who can’t tolerate NSAIDs/colchicine or have kidney disease).^1,2 We can prescribe these for rapid relief during attacks.^1,2

Chronic urate-lowering therapy – The cornerstone of gout management that prevents future attacks and reduces crystal deposition.¹ Allopurinol (xanthine oxidase inhibitor, first-line) or febuxostat (an alternative for patients who don’t reach target uric acid on allopurinol, can’t tolerate it, or have contraindications, taking comorbidities and preferences into account).¹ Goal is to lower serum uric acid below 6 mg/dL (and consider <5 mg/dL for patients with tophi, chronic gouty arthritis, or ongoing frequent flares despite being below 6 mg/dL) to dissolve existing crystals and prevent new formation.¹ Usually started 2 to 4 weeks after an acute flare resolves, though it can be started during a flare if flares are frequent, with colchicine prophylaxis during initiation to prevent flares triggered by fluctuating uric acid levels.¹ We titrate doses based on lab monitoring to achieve target levels.¹

For patients with frequent or troublesome flares, tophi, chronic kidney disease, chronic gouty arthritis, or uric acid kidney stones, urate-lowering therapy is often long-term and may be lifelong.^1,2 If colchicine cannot be used for flare prophylaxis during ULT initiation, a low-dose NSAID or low-dose oral corticosteroid may be considered.¹ Our approach prevents the progressive joint destruction and disability that results from untreated chronic gout.¹

References

1. National Institute for Health and Care Excellence. Gout: diagnosis and management. NICE guideline NG219. Published June 9, 2022. Accessed April 14, 2026.
2. Mayo Clinic Staff. Gout: diagnosis and treatment. Mayo Clinic. November 16, 2022. Accessed April 14, 2026.