In the management of acute gout, which of the following is NOT appropriate?

In the management of acute gout, starting allopurinol during an acute flare is not appropriate because allopurinol is a urate-lowering medication that is intended for long-term management of gout and prevention of future flares. When a patient experiences an acute gout attack, the focus should be on managing pain and inflammation rather than initiating medications that may take time to become effective.

Allopurinol works by inhibiting xanthine oxidase, which decreases uric acid levels over time, but it can potentially worsen acute symptoms by mobilizing uric acid if started during an active flare. Instead, medications such as nonsteroidal anti-inflammatory drugs (like indomethacin), colchicine, or corticosteroids are more appropriate choices for managing the acute pain and inflammation associated with gout attacks. These options target the immediate symptoms rather than attempting to lower uric acid levels, which is not the goal during an acute episode.

Understanding the role of each medication in the context of an acute gout flare helps in making effective treatment decisions.