First-line therapy for an acute gout flare is which NSAID?

• A. Acetaminophen
• B. Celecoxib
• C. Indomethacin
• D. Naproxen

Answer: (C)

An acute gout flare is driven by intense inflammation from urate crystals, so the first priority is rapidly suppressing that inflammatory response with a potent NSAID. Indomethacin is the classic first-line choice because it provides strong anti-inflammatory effects and fast relief of joint swelling and pain. It works by broadly inhibiting prostaglandin synthesis in inflamed tissues, which directly dampens the neutrophil-driven inflammatory cascade seen in gout. While other NSAIDs like naproxen can be effective, indomethacin has the strongest historical support for acute gout management. Acetaminophen lacks anti-inflammatory action and is not sufficient to treat the inflammatory component. Celecoxib, a COX-2 inhibitor, can be used in patients with GI risk but is not the traditional first-line in this scenario due to differing efficacy data and considerations.