Approaches to acute and chronic gout management differ. For acute episodes, NICE recommends managing symptoms with a non-steroidal anti-inflammatory drug (NSAID), such as naproxen, at its maximum dose (along with a proton pump inhibitor (PPI) for gastric protection). Paracetamol may also be suggested as an adjunct for pain relief, along with ice packs.[13]

Colchicine should be taken at 500 microgrammes 2-4 times a day to a maximum of 6mg per course, with at least three days between each course.[18]

A short course of oral corticosteroid, such as prednisolone 30-35 mg once a day for 3-5 days may also be considered although this is an off-label use. Corticosteroid injections (into the joint or intramuscularly) may be offered (off-label) if NSAIDs and colchicine are unsuitable.[13]

An IL-1 beta inhibitor (initiated by the rheumatology service) should only be considered for gout flare if NSAIDs, colchicine and corticosteroids are contraindicated, not tolerated or ineffective.[1,13]

Serum urate levels should be monitored 4-6 weeks after a gout flare has settled. Hypertensive patients taking a diuretic may benefit from being switched to a different type of antihypertensive. Heart failure patients using a diuretic treatment should continue with this during an acute attack.[13]