Which medication is contraindicated during an acute gout attack?

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

Answer: (A)

During an acute gout attack, the aim is to quickly quell inflammation and pain from crystal-induced joint inflammation. Medications that do this effectively include NSAIDs (like indomethacin), colchicine, and corticosteroids (such as prednisone). Allopurinol, on the other hand, lowers uric acid production as a long-term strategy to prevent future flares, but it does not provide rapid anti-inflammatory relief. Initiating urate-lowering therapy during an acute attack can destabilize the crystal balance and may mobilize urate from stores, potentially worsening or prolonging the flare. Because of this, starting allopurinol during an acute episode is avoided; it is better to manage the flare with appropriate anti-inflammatory therapy and begin urate-lowering treatment after the attack has resolved to reduce the risk of a renewed flare.