Gout treatment has different jobs. Flare medicines calm inflammation and pain. Urate-lowering medicines reduce the urate burden over time. Some people also receive an anti-inflammatory to help prevent attacks when long-term treatment is started or adjusted. Knowing which medicine does what makes the plan easier to follow. [S02] [S03]

During a flare

Colchicine, NSAIDs, and corticosteroids are common first-line options. Suitability depends on kidney function, other conditions, other medicines, and your preferences. The right choice for someone else may be wrong for you. S02 S03

When to discuss long-term treatment

ACR strongly recommends urate-lowering therapy for tophi, gout-related damage on imaging, or at least two flares a year. Other situations receive conditional recommendations, including some first attacks with kidney disease, very high urate, or stones. NICE uses broader offer-and-discussion criteria. The decision should reflect your disease burden, risks, and priorities. S02 S03

Treatment needs a target and follow-up

Where recommended, clinicians start low and adjust the dose using blood urate and safety checks. A starting dose is not necessarily the dose that will reach target. Early flares can occur as urate changes, so preventive anti-inflammatory treatment is often part of the initial plan. S02

Where the main medicines fit

Allopurinol: ACR’s preferred initial urate-lowering option, including in chronic kidney disease.
Febuxostat: another urate-lowering medicine, with a US cardiovascular death boxed warning and a restricted place after allopurinol is unsuitable or inadequate.
Probenecid: increases urate removal through the kidneys; kidney function, stones, and interactions matter.
Specialist treatment: options such as pegloticase or selected IL-1 treatment require specialist assessment and monitoring. S02 S11 S12 S13 S14

Leave the appointment knowing the purpose

Ask what each medicine is for, how to take it, what target you are aiming for, what side effects need action, and when the next review is. Bring up costs and access too. A plan has to be workable as well as medically appropriate.

Gout treatment: flare relief and longer-term control

In this section

Urate-lowering therapy: treating gout over time

Allopurinol: what it does and what to watch for

Febuxostat: its role and cardiovascular warning

Probenecid: helping the kidneys remove urate

Colchicine: follow the exact product and directions

NSAIDs for a gout flare

Corticosteroids for a gout flare

When gout needs specialist treatment

Urate targets, blood tests, and follow-up

Gout medicines: interactions and safety

During a flare

When to discuss long-term treatment

Treatment needs a target and follow-up

Where the main medicines fit

Leave the appointment knowing the purpose

Sources

In this section

Urate-lowering therapy: treating gout over time

Allopurinol: what it does and what to watch for

Febuxostat: its role and cardiovascular warning

Probenecid: helping the kidneys remove urate

Colchicine: follow the exact product and directions

NSAIDs for a gout flare

Corticosteroids for a gout flare

When gout needs specialist treatment

Urate targets, blood tests, and follow-up

Gout medicines: interactions and safety

During a flare

When to discuss long-term treatment

Treatment needs a target and follow-up

Where the main medicines fit

Leave the appointment knowing the purpose

Related pages

Sources