Several classes of antiinflammatory agents are effective for the treatment of gout flares, including systemic and intraarticular glucocorticoids, nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, and biologic agents that inhibit the action of interleukin (IL) 1 beta. A set of general principles is important in the effective management of a gout flare, regardless of the specific antiinflammatory agent used. These include the following:

Early treatment – Treatment should start as soon as possible after the patient perceives the beginning of a flare, preferably within several hours of symptom onset. More rapid and complete resolution of symptoms occurs the earlier that treatment is introduced, especially if treatment is initiated at the full recommended dose of the chosen antiinflammatory agent. Patients should be continued on treatment for the duration of the flare, usually at reduced doses once a significant reduction in symptoms is achieved. Duration of therapy – Complete cessation of treatment for a gout flare can usually be safely done within two to three days of complete resolution of the flare; however, in the case of oral glucocorticoids, we sometimes taper more slowly to lower the risk of a recurrent ("rebound") flare. (See 'Oral glucocorticoids' below and 'Administration of NSAIDs' below and 'Administration and standard dosing of colchicine' below.)

The duration of therapy for a gout flare may range from only a few days (eg, in a patient treated within hours of symptom onset) to several weeks (eg, in a patient begun on treatment after four or five days of symptoms). Many patients require antiinflammatory treatment for a gout flare for no more than five to seven days if begun on therapy within 12 to 36 hours of symptom onset.

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