Allopurinol increases uric acid elimination and is useful during an acute attack.
+Colchicine should not be used prophylactically.
+If NSAIDs are contraindicated, intramuscular injections of ACTH are useful.
+Probenecid lowers uric acid by diminishing production.
+Response to colchicine is diagnostic for the disease.
Colchicine is effective for gout, pseudogout, and other crystal arthritides, so it cannot be used to make the specific diagnosis of gout. Long-term therapy of gout is designed to decrease serum uric acid levels either by decreasing production (allopurinol) or increasing excretion (probenecid). ACTH is also recommended for those patients with contraindications to NSAIDs. The dose of ACTH is 40–80 IU given IM. Uric acid lowering agents should not be started during an acute attack. Colchicine may be given prophylactically for 6–12 months to suppress flare-ups.