How is an acute gout attack typically treated? (NSAIDs, colchicine, corticosteroids)

When gout strikes, an acute attack can be excruciating. Your foot swells up like a bun, and you can't even touch it. The key to treatment is one word: speed! The earlier you take medication, the better the effect and the less pain you'll experience. Generally, doctors will choose from the following three types of medications based on your specific condition:

1. Non-steroidal Anti-inflammatory Drugs (NSAIDs)

What are they? You can think of them as stronger 'painkillers,' such as the familiar ibuprofen, naproxen, and diclofenac (Voltaren). They are the first-line treatment for acute attacks because they quickly reduce inflammation and relieve pain.
How to use? As soon as you feel something is wrong with your joint or notice signs of an attack, take them immediately. Make sure to take the full dose; don't reduce it yourself, or the effect won't be good. It's best to take them after meals to minimize stomach irritation.
What to watch out for? If you have stomach ulcers, kidney disease, or are taking certain anticoagulant medications, be sure to inform your doctor before use. They will help assess the risks.

2. Colchicine

What is it? This is a 'specialized old drug' for treating gout, specifically targeting gout inflammation.
How to use? This medication emphasizes 'early' use. It's best to take it within 12-24 hours of an attack; the earlier, the more effective. The current usage differs from the past; small doses are now preferred, for example, taking two tablets first, then one tablet an hour later, and subsequently taking it daily. Absolutely do not take it every one or two hours as was done previously, as that leads to excessive side effects like vomiting and diarrhea.
What to watch out for? This drug has a narrow 'therapeutic window,' meaning taking too much can easily lead to poisoning. Therefore, you must strictly follow your doctor's instructions and never increase the dose on your own! If you have impaired liver or kidney function, your doctor will specifically adjust the dosage.

3. Glucocorticoids

What are they? These are what we commonly call 'steroids,' such as prednisone. They have very strong anti-inflammatory effects and are a 'trump card' for quickly suppressing pain.
How to use? Generally, doctors only consider using steroids when the above two medications are ineffective, or when the patient cannot use those two medications due to medical reasons. Sometimes, if only one joint is severely swollen, the doctor might even inject it directly into the joint for faster relief.
What to watch out for? Steroids should not be used indiscriminately or long-term; they are primarily for 'emergency' situations. Typically, they are used for a few days, and when discontinuing, the dose must be gradually reduced, not stopped abruptly, as this could cause the condition to rebound.

To summarize, treating an acute attack is like fighting a fire:

First choice: NSAIDs, quick and convenient.
Alternative: Colchicine, especially suitable for early stages of an attack.
Last resort: Glucocorticoids, for severe cases or when the first two cannot be used.

Finally, in addition to medication during an acute attack, remember a few points: rest the affected joint, elevate it, apply cold compresses with ice wrapped in a towel (don't apply ice directly, it can cause frostbite), and drink plenty of water (plain water is best) to help excrete uric acid.

The most important point: these medications only 'treat the symptoms, not the root cause'; they merely help you get through the painful acute phase. Once the pain subsides, you must see a doctor for a systematic check-up and begin long-term uric acid-lowering treatment (such as allopurinol or febuxostat) to reduce uric acid levels. Only then can you truly reduce or even prevent future gout attacks.