First-line treatments for acute gout attacks include offering one of the following as soon as possible: a nonsteroidal anti-inflammatory drug (NSAID) at the maximum dose (e.g., naproxen), continuing treatment until 1-2 days after attack resolution, and considering a proton pump inhibitor (PPI) for gastric protection; colchicine; or a short course of oral corticosteroids such as prednisolone 30-35 mg once daily for 3-5 days (noting this is off-label).
If NSAIDs and colchicine are not tolerated or ineffective, consider intra-articular or intramuscular corticosteroid injections (off-label use).
For pain relief, consider adding paracetamol as an adjunct and use ice packs applied to the affected joint to alleviate pain.
If response to monotherapy is inadequate, consider combining treatments.
Do not offer interleukin-1 (IL-1) inhibitors unless NSAIDs, colchicine and corticosteroids are contraindicated, not tolerated or ineffective, and refer the person to a rheumatology service before prescribing IL-1 inhibitors.
Lifestyle advice includes advising the person to rest and elevate the affected limb, keep the joint exposed and cool (e.g., with an ice pack), continue urate-lowering therapy if already prescribed, and return if symptoms worsen or do not improve after 1-2 days.