Treatment
Flare medicines compared
Colchicine, NSAIDs, and steroids are the three kinds of medicine the 2020 ACR guideline names first for a gout flare. All three are options. Which one fits depends on you, and that choice is made with a clinician.
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What the guideline says
The 2020 ACR guideline strongly recommends colchicine, NSAIDs, or glucocorticoids (steroids) as appropriate first-line treatment for a gout flare. It does not rank them. The guideline says the choice among them is based on the person: their other conditions, other medicines, past experience, and preferences. For people who cannot take medicine by mouth, it strongly recommends steroids given by injection.
This page is a way to understand that conversation. It does not say which one you should take, how much, or for how long. Do not start, stop, or switch a medicine because of this page.
Side by side
The order below is not a ranking.
| Medicine | How it is given | Who may not be able to take it, per MedlinePlus |
|---|---|---|
| Colchicine | By mouth. NIAMS says it works best when taken when symptoms first appear. | MedlinePlus says to tell your clinician about kidney or liver disease or blood problems, and that your clinician may tell you not to take it. Some medicines should not be taken with it, and MedlinePlus says not to eat grapefruit or drink grapefruit juice during treatment. Stomach upset and diarrhea are common side effects. |
| NSAIDs (for example, naproxen or ibuprofen) | By mouth. Some are sold over the counter; NIAMS mentions over-the-counter or prescription anti-inflammatories. | MedlinePlus warns NSAIDs can cause stomach or intestinal ulcers and bleeding, with higher risk in older people and with blood thinners, steroids, and some antidepressants. It also lists heart disease or stroke risk, kidney disease, heart failure, and pregnancy as things to tell your clinician. |
| Corticosteroids (steroids, for example prednisone) | By mouth, or injected into the joint (NIAMS). The 2020 ACR guideline also names injection into a muscle. | MedlinePlus says to tell your clinician if you have diabetes, high blood pressure, an infection, ulcers, osteoporosis, or liver, kidney, or heart disease. Steroids can lower the ability to fight infection, and some products interact with them. |
Things that shape the choice
- Kidneys. Kidney disease comes up for colchicine and for NSAIDs in the MedlinePlus information, and for steroids too.
- Stomach and bleeding. A past ulcer, stomach bleeding, or a blood thinner matters especially for NSAIDs.
- Diabetes. MedlinePlus asks people to tell their clinician about diabetes before prednisone, and lists diabetes among heart-risk factors to mention before an NSAID.
- Other medicines. Each of the three has interactions. Bring a written list of everything you take, including over-the-counter medicines and supplements, as MedlinePlus advises.
- Pregnancy and breastfeeding. Tell the clinician; it changes the choice.
If you already take a urate-lowering medicine such as allopurinol, ask before changing it during a flare. As a long-term plan, the 2020 ACR guideline conditionally recommends continuing urate-lowering medicine indefinitely over stopping it.
Questions to bring
- Which flare medicine is right for me, given my kidneys, stomach, and other medicines?
- What should I do if a flare starts at night or on a weekend?
- Which side effects mean I should call you?
More on the questions page and the printable sheet.
Related: Medicines, by name, During a flare.
Clinical claims on this page follow the sources.