Why is allopurinol not used during an acute gout attack?

• A. It does not treat acute gout.
• B. It worsens kidney function.
• C. It rapidly lowers uric acid.
• D. It is contraindicated in all patients.

Answer: (A)

Allopurinol is a chronic urate-lowering medicine used to reduce uric acid levels and prevent future gout attacks, not to treat the current inflammation of an acute flare. In an acute gout attack, the goal is to rapidly control pain and swelling with anti-inflammatory therapies such as NSAIDs, colchicine, or steroids. Starting or continuing allopurinol during the flare doesn’t address the inflammatory symptoms and can potentially worsen or prolong the attack by altering urate levels when crystals are already irritated. Because it doesn’t provide immediate relief, its role is preventive—beginning or resuming urate-lowering therapy after the acute episode has subsided.