What is the first-line treatment for acute gout flares involving only one or two joints?

• A. Colchicine
• B. NSAIDs indomethacin (lipid soluble)
• C. Steroids
• D. Allopurinol

Answer: (B)

When a gout flare is limited to one or two joints, the goal is to quickly dampen the inflammatory response driven by monosodium urate crystals in the joint. Nonsteroidal anti-inflammatory drugs do this most effectively by inhibiting cyclooxygenase and reducing the prostaglandins that fuel pain and swelling. Indomethacin is a common choice because it provides strong, rapid anti-inflammatory effects and its lipophilicity helps the drug reach the inflamed joint quickly, leading to faster relief with a relatively short course.

Colchicine can be used, especially if NSAIDs are not suitable, but it often has slower onset and more GI side effects. Steroids are a good alternative if NSAIDs are contraindicated or not tolerated, and they can be given orally or injected into the affected joint. Allopurinol, on the other hand, lowers uric acid but is not used to treat an acute attack; it’s intended for long-term urate lowering and is managed separately from the immediate flare.

So for a quick, effective relief of a single or two-joint gout flare, an NSAID like indomethacin stands as the best first-line option.