What is the most appropriate first-line course of action for an acute gout attack in a patient not on long-term prophylaxis?

• A. Ibuprofen
• B. Allopurinol
• C. Colchicine
• D. Indomethacin

Answer: (A)

Acute gout is driven by inflammation from urate crystals, so the first priority is rapid suppression of this inflammation with a nonsteroidal anti-inflammatory drug. An NSAID like ibuprofen provides effective pain and swelling relief and is a sensible initial choice when there are no contraindications.

Starting allopurinol during an acute flare is not appropriate because lowering urate levels at that moment can worsen or prolong the attack; urate-lowering therapy is aimed at preventing future flares and is started after the acute episode settles. Colchicine can be used if NSAIDs are unsuitable, but it has a narrow therapeutic window and more GI toxicity, making NSAIDs a more straightforward first-line option in most patients. Indomethacin is also an NSAID and effective, but ibuprofen is a common, well-tolerated first-line alternative that fits many acute-care scenarios.