How should acute gout and chronic gout be managed?

Acute flare: NSAIDs (indomethacin, naproxen), colchicine (low-dose preferred), or corticosteroids—choice based on comorbidities. Ice and rest. Do not start or stop ULT during acute flare. Chronic management: urate-lowering therapy (ULT) for recurrent flares, tophi, or CKD. Allopurinol first-line, titrate to serum urate <6 mg/dL. Febuxostat if allopurinol intolerant. Prophylaxis with low-dose colchicine or NSAID for 3-6 months when starting ULT.