After a long, busy day under the sweltering summer sun, nothing seems more inviting than sitting down at a roadside barbecue stand as night falls. With a few skewers of grilled delights and a couple of ice-cold beers, the day's fatigue melts away, and you feel rejuvenated, rekindling your love for life. Your taste buds and soul are doubly satisfied, ready for a restful night's sleep. 

When your toes are red, swollen, and painful, especially if you have a history of high uric acid levels, it is quite likely that you're experiencing a gout attack. Gout occurs when there is an excess of uric acid in the blood, which can form needle-like crystals in the joints, leading to inflammation and intense pain. The affected joint area typically exhibits signs of redness, swelling, warmth, and severe pain.

According to the "Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout in China (2019)," when a patient experiences an acute gout attack, it is recommended to start treatment as early as possible with low-dose colchicine or nonsteroidal anti-inflammatory drugs (NSAIDs) used in full doses for a short course. Here¡¯s how these treatments should be applied:

Let's start with the first drug: a small dose of colchicine
Question 1: What does colchicine do?

Colchicine is a highly effective medication used specifically for treating acute gout attacks. It works best when administered as early as possible during the onset of symptoms. The primary action of colchicine is to prevent the white blood cells from migrating into the joint area, which are responsible for the inflammatory response triggered by uric acid crystals. By inhibiting this migration, colchicine helps reduce pain, swelling, and inflammation associated with a gout flare-up. However, it does not affect the level of uric acid in the blood.

Question 2: Why small doses?
Because the therapeutic amount of colchicine is very close to the toxic amount, there are more adverse reactions, so it is generally recommended to start with a small dose when treating. It might look like the following:

Note: Although all are colchicine tablets, some dosages are different! In an acute episode, take 2 tablets if it's a 0.5mg dose, but take 1 tablet if you get a 1mg dose, don't overdo it!

Now let's look at the second drug: nonsteroidal anti-inflammatory drugs
Question 1: What are non-steroidal anti-inflammatory drugs and what are their effects?

non-steroidal anti-inflammatory drugs belong to a category of drugs distinct from corticosteroids, which have a steroid (or steroidal) structure. Steroid hormones possess a characteristic four-ring structure known as the steroid nucleus. Drugs that do not have this steroid structure but exhibit similar anti-inflammatory effects are classified as nonsteroidal anti-inflammatory drugs (NSAIDs). There are various types of NSAIDs available, including commonly known ones such as aspirin, diclofenac, indomethacin, and ibuprofen.

Question 2: Which should I eat when I have a gout attack?

According to the "Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout in China (2019)," it is recommended to initiate treatment early and use a full therapeutic dose of nonsteroidal anti-inflammatory drugs (NSAIDs). The guidelines suggest prioritizing NSAIDs that take effect quickly and have fewer adverse reactions. One such preferred option is etoricoxib.

Note: Although they are the same type of medication, there can be significant differences in dosage between different NSAIDs, so it is important not to switch medications arbitrarily without consulting a healthcare provider.

Additionally: If you are someone who is on long-term low-dose aspirin therapy, it is recommended to use celecoxib. Celecoxib might look like this:

Since each capsule has the same dose, it is possible to replace one with another if one is gone.

Note: The following point is extremely important:

If you regularly take urate-lowering medication, you can continue taking it during an acute gout attack. However, if you do not normally take urate-lowering drugs, you should not start taking them during an acute attack due to the urgency of managing symptoms. Initiating urate-lowering therapy during a flare can actually exacerbate the pain and potentially prolong the attack.