Treatment
1. Steroid - options are intra-articular injection, oral steroid, or intramuscular injection of steroid. Intra-articular steroid + lido w/o (I like triamcinolone the best) 20 mg for small joints is perfect. For the intramuscular injection, I like 40 mg triamcinolone and 20 mg dexamethasone in the same syringe injected into the gluteus. For the oral steroid, I like Prednisone 40 mg every morning for seven days. The prescription will read prednisone 20 mg, two tabs PO Qa.m. x 7d, #14 0RF. 2. Colchicine 0.6 mg tabs - two tabs by mouth once and then one tab by mouth an hour later. 3. NSAID - I prefer 500 mg of naproxen twice a day for seven days. Just be careful with the NSAID and steroid combination. If prescribing oral steroids, I put patients on famotidine 40 mg one tablet by mouth twice a day for 14 days Do not prescribe allopurinol for acute gout flair. Wait until they are six weeks resolved to initiate that, otherwise you can cause an acute flare/worsening of the gout. However, they are already on allopurinol, continue it. ==References==