What treatment is recommended in acute gout?
• Prescribe a nonsteroidal anti-inflammatory drug (NSAID) such as diclofenac, indometacin, or naproxen as soon as possible, and continue the treatment until 48 hours after the attack has resolved. • Co-prescribe a proton pump inhibitor (PPI) or misoprostol for gastric protection in people at risk of peptic ulcers, gastric bleeds, or perforations. For more information, see Preventing GI adverse effects in the CKS topic on NSAIDs – prescribing issues. • If NSAIDs are contraindicated, not tolerated, or have been ineffective in previous attacks, prescribe oral colchicine 500 micrograms, two to four times a day, until relief of pain is achieved, or diarrhoea or vomiting occurs. • If NSAIDs and colchicine are contraindicated, consider systemic corticosteroids. • Use paracetamol, with or without codeine, in addition to other drug treatment, or alone, if NSAIDs, colchicine, and corticosteroids are all contraindicated. • In people who are already established on allopurinol or febuxostat urate-l
