Patients usually only require opioid and NSAID treatment in the ED with continued NSAID treatment as an oupatient. However any combination of the following treatments are acceptable
Hold diuretics
Consider starting losartan to replace diuretic (has modest uricosuric effect)
Alcohol and dietary counseling
Continue uric acid-lowering agents if already on prophylactic regimen (do not start)
Follow up with Primary Doctor or Rheumatology if having continued flares
Do not give to patients with renal insufficiency (use opioids instead)
Substantial pain relief should occur within 2hr
Options:
Indomethacin 50mg po TID x3-5d, OR
Naproxen 500mg po BID x3-7d, OR
Ibuprofen 800mg PO TID x 3-5d
Indomethacin 50mg po TID x3-5d, OR
Naproxen 500mg po BID x3-7d, OR
Ibuprofen 800mg PO TID x 3-5d
Can be used as alternative agent to NSAIDs in patient with normal renal/hepatic function
1.2mg PO (load), followed by 0.6mg one hour later x 1 
May use to maximum of x3 doses, with more aggressive regimens totaling max dose up to 6mg
Wait at least x3 days before starting another round of colchicine therapy
Renal impairment not absolute contraindication for acute flare but may consider dose reduction.
Dose adjustments for CYP3A4 inhibitors (HARRT, Calcium Channel Blockers, fluconazole, erythromycin, clarithromycin)
Colchicine should not be administered intravenously
Initial: 0.6-1.2mg, followed by 0.6 every 1-2 hours; some clinicians recommend a maximum of 3 doses; more aggressive approaches have recommended a maximum dose of up to 6mg. Wait at least 3 days before initiating another course of therapy
Prednisone 30 to 50mg initially, and gradually tapered over 10 days, results in clinical resolution without rebound pain or complications
Even if<unk>  has been diagnosed in the past, be cautious with glucocorticoid joint injection if the current clinical picture is uncertain since a septic joint can coexist with<unk>  and a steroid injection would then worsen the patient's clinical status.

Anakinra
Disease-modifying agent; Interleukin-1 Receptor Antagonist
Reserve use for patients who have frequent flares and in whom first-line therapies are ineffective, contraindicated, or not tolerated
100 mg subq once daily until symptom improvement; usual duration: 3 to 5 days
NOT routinely used in the ED.
Disease-modifying agent; Interleukin-1 Receptor Antagonist
Reserve use for patients who have frequent flares and in whom first-line therapies are ineffective, contraindicated, or not tolerated
100 mg subq once daily until symptom improvement; usual duration: 3 to 5 days
NOT routinely used in the ED.
Gout and pseudogout
Acute osteoarthritis
Boxer's fracture
Avascular necrosis
Colles' fracture
Crystal-induced 
Salter-Harris fractures
Gonococcal arthritis, arthritis-dermatitis syndrome