For an acute gout attack, which drug class is used first-line?

• A. Acetaminophen
• B. Colchicine
• C. NSAIDs
• D. Opioids

Answer: (C)

Managing an acute gout flare is all about rapid control of inflammation and pain. Nonsteroidal anti-inflammatory drugs are the first-line choice because they directly dampen the inflammatory response by blocking COX enzymes and reducing prostaglandin production. This speeds relief from both pain and joint swelling, which is crucial in a sudden attack. Acetaminophen can help with pain but doesn’t address inflammation; colchicine works but has slower onset and more GI side effects and is often used when NSAIDs can’t be used; opioids are reserved for severe cases due to risk of dependence and other side effects. NSAIDs are preferred unless there are contraindications (like certain kidney, stomach, or bleeding concerns), in which case alternatives such as colchicine or corticosteroids are used.