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For acute flares, potent NSAIDs are a first-line option; colchicine and glucocorticoids are alternatives selected according to the clinical situation. Colchicine limits neutrophil activity but has important gastrointestinal, muscle, and blood-cell adverse effects, with dose considerations in organ impairment and certain drug interactions. IL-1 inhibitors may be used for flares not controlled by standard therapy. Long-term urate-lowering therapy is considered for specified clinical features, with a serum urate target that is lower in tophaceous disease. Allopurinol is the preferred initial urate-lowering drug in the source, while febuxostat, uricosuric agents, and pegloticase have distinct roles and precautions. Managing gout therefore requires attention to both treatment goals and medication-specific risks.