A 57-year-old man, previously asymptomatic and on no medications, develops a painful left big toe. It is so painful that even the weight of his sheets is excruciating. On examination, there is a swollen red toe. Which of the following medications is relatively contraindicated?

Uricosuric drugs and allopurinol have no role in the treatment of acute gouty arthritis. Salicylates are also not used in the treatment of gout. The treatments of choice are colchicine, NSAIDs, and intra-articular steroid injection. Response is best when initiated early in the disease. Colchicine can be given intravenously to avoid GI distress. A short course of systemic corticosteroids is also quite effective therapy. Allopurinol is started only when all inflammation is gone and colchicine prophylaxis has been started. It is not always required.