Treatment of acute gouty arthritis: one physician's approach and where this management stands relative to developments in the field.

An attack of acute gouty arthritis is one the most painful episodes that can be experienced by humans. Fortunately, there are three classes of agents that can effectively terminate the acute attack. These include colchicine, nonsteroidal anti-inflammatory drugs, and glucocorticoids. If therapy with any one of these is initiated promptly after the onset of symptoms, relief should occur quickly. Recent observations have increased the knowledge of crystal-induced acute inflammatory responses. These observations allow a better understanding of the mechanisms of action of these agents and provide the rationale for using them in combination in severe or refractory cases.