Which of the following medications is a first-line treatment for an acute gout attack?

Colchicine is recognized as a first-line treatment for an acute gout attack primarily due to its mechanism of action and effectiveness in reducing inflammation associated with gout flares. It works by inhibiting the migration of inflammatory cells into the affected joint and reducing the production of inflammatory mediators, which helps alleviate the symptoms of pain and swelling during an acute attack.

The use of colchicine is well-established in clinical guidelines for the management of acute gout, particularly when administered early in the course of the attack. It can effectively reduce the severity and duration of symptoms, making it a preferred choice among available treatment options.

Other medications, while important in gout management, do not serve as first-line treatments for acute attacks. For instance, febuxostat is a xanthine oxidase inhibitor primarily used for chronic management and prevention of gout flares rather than acute treatment. Hydrochlorothiazide is a diuretic that may actually exacerbate gout by increasing uric acid levels, and metformin is primarily used in the management of diabetes and does not have a role in treating acute gout attacks. This delineation highlights the specific use of colchicine in the acute setting, emphasizing its relevance in the clinical approach to managing gout flares.