**Question:** Drug of choice for the treatment of acute gout in patients in whom NSAIDs are contraindicated is-

A. Colchicine
B. Glucocorticoids
C. Colchicine and Glucocorticoids
D. Colchicine and NSAIDs

**Correct Answer:** A. Colchicine

**Core Concept:** Gout is a form of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints, leading to pain, swelling, and inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for acute gout management but are contraindicated in certain patients due to potential adverse effects or comorbidities.

**Why the Correct Answer is Right:** Colchicine is a drug primarily used for gout prevention, acting by reducing the inflammatory response. Its mechanism of action involves inhibition of microtubule assembly, preventing neutrophil diapedesis and chemotaxis, ultimately reducing inflammation. In patients with contraindications to NSAIDs, colchicine is a suitable alternative for acute gout management, as it provides pain relief without the risks associated with NSAIDs.

**Why Each Wrong Option is Incorrect:**

B. Glucocorticoids: While glucocorticoids can provide rapid pain relief, they are not the preferred choice due to their significant side effect profile, including immunosuppression, increased risk of infection, and long-term complications.

C. Colchicine and Glucocorticoids: Combining both drugs does not necessarily provide better efficacy or reduced side effects compared to colchicine alone, as they have overlapping mechanisms of action and increased risk of adverse events.

D. Colchicine and NSAIDs: Combining these drugs is not recommended due to the contraindications of NSAIDs in these patients, making colchicine a safer alternative for acute gout management.

**Clinical Pearl:** In patients with gout and contraindications to NSAIDs, colchicine is a safe and effective alternative for managing acute gout attacks. However, it is important to note that colchicine should be prescribed with caution due to its potential side effects, such as gastrointestinal upset and myopathy. Close monitoring and dose adjustment are crucial in these patients.