Patient case (clinical description): A 39-year-old man comes to the emergency department with an acute onset of severe left toe pain.  The toe is red and exhibits swelling. The patient is not febrile, and does not remember any recent trauma. Medical history is not significant except for the similar attacks and the diagnosis of gouty arthritis. His medication history includes Allopurinol to prevent gouty attacks. His father has the same medical condition. However, his older brother who is 41 years old is healthy with no history of gouty arthritis. Physical examination shows a swollen, tender first metatarsophalangeal joint.  Aspiration of the joint showed high leukocyte count, negative Gram stain, and numerous needle-shaped crystals, which is compatible with gouty arthritis.

Patient's own account: I'm a 39-year-old man and got admitted to the ER after an unbearable pain in my left toe. My toe was red and terribly swollen. I was still standing on my feet, not febrile and I don't remember hitting my head or anything. I don't have any special medical history, but I had been diagnosed with gout before. I take Lopurin to prevent my gouty attacks. My dad had the same problem, but my 41-year-old brother is healthy and does not have gouty attacks. The doctor did a physical exam and found that the joints between my toes and the rest of my foot were swollen and tender. The doctor renewed his diagnosis of gouty arthritis.

Clinical trial: Bucillamine for the Treatment of Acute Gout Flare in Subjects With Moderate to Severe Gout

Eligibility criteria:
Inclusion Criteria:

          -  Subjects must present with confirmed diagnosis of gout, meeting the American College
             of Rheumatology (ACR) 1977 preliminary criteria for the classification of acute
             arthritis of primary gout

          -  Subjects must have experienced at least one (1) acute gouty arthritic attack in the 12
             months prior to randomization

          -  Presence of acute gout flare for no longer than 3 days at Visit 2

          -  Pain intensity at inclusion (Visit 2) of 7-10 on 11-point PI-NRS (defined as severe
             gout flare for this study)

          -  All patients should not have contraindications for Colchicine use

          -  Subjects with a history of intolerance to NSAIDs (Checklists Checklist 1)

          -  Subjects with significant medical contraindication to NSAIDs (Checklist 2)

          -  Subjects with past failure of NSAIDs to control acute gouty arthritis attacks in the
             previous 12 months (Checklist 3)

          -  Regarding significant medical contraindication to NSAIDs or past failure of NSAIDs to
             control acute gouty arthritis attacks in the previous 12 months (i.e. refractoriness
             to NSAIDs) the patient must meet one of below criteria:

               1. At least one historical episode within the previous 12 months of being refractory
                  or intolerant to NSAIDs that makes the physician concerned to use NSAIDs for a
                  subsequent acute gout attack

               2. The current (referring) physician judgment is that NSAIDs are not appropriate for
                  treating the patient's gouty arthritis flare which may be due to changes in
                  patient status such as worsening co-morbid conditions or co-medications (e.g., GI
                  tract disease, renal insufficiency, hypertension, fluid retention, concurrent use
                  of diuretics and/or an angiotensin converting enzyme inhibitor or angiotensin
                  receptor blocker, especially in CKD)

          -  Subjects must be willing and able to give written informed consent. A HIPAA and/or
             state privacy consent must also be signed

          -  Subjects must be able to swallow tablets

          -  Use of permitted concomitant medications must be unchanged in dose and or frequency,
             30 days prior to screening

          -  Adequate organ function, evidenced by the following laboratory results within 90 days
             prior to randomization (historical lab results are acceptable).

          -  Creatine clearance > 45 mL/min based on Cockroft-Gault glomerular filtration rate
             (GFR) estimation

          -  For women of childbearing potential and men with partners of childbearing potential,
             agreement to use a highly effective, non-hormonal form of conception.

        Exclusion Criteria:

          -  Subjects with rheumatoid arthritis, psoriatic arthritis, evidence/suspicion of
             infectious/septic arthritis, acute polyarticular gout (4 or more joints), with
             arthritis due to any cause other than gout that may confound any study assessments per
             Investigator discretion

          -  Subjects who have experienced >2 acute gouty arthritic attacks per month, or >12
             attacks overall, in the 6 months prior to randomization

          -  Subjects with a history of myocardial infarction, unstable angina, cerebrovascular
             events, or coronary artery bypass grafting within the previous 6 months prior to
             screening

          -  Subjects with a Body Mass Index >45 kg/m2; calculated as body weight (kg)/height (m)2
             at Screening Visit

          -  Subjects with acute or chronic infections including known HIV and/or Hepatitis B or C

          -  Uncontrolled hypertension (>160/90 mmHg seated) (if the first set of BP assessment
             meets the definition of uncontrolled hypertension, a second set of BP assessments may
             be performed after the patient has rested for at least 30 min. If the second set of BP
             assessments does not meet the definition of uncontrolled hypertension the patient will
             be eligible for participation)

          -  Subjects with proteinuria ≥1+ or ≥30 mg on dipstick urinalysis that is confirmed on
             repeat assessment within 24 hours

          -  Subjects with significant heart failure and activity impairment (Class III-IV of the
             New York Heart Association (NYHA)

          -  Subjects with any history of malignancy, 5 years prior to randomization

          -  Subjects with CKD NKF stages 3B -5 chronic renal dysfunction (eGFR <45 mL/min/1.73m2
             acc. to Cockcroft Gault formula)

          -  Subjects with serious hepatic disorder (Child-Pugh scores B or C)

          -  Subjects who have not washed out of dopamine antagonists or depleting drugs excluding
             anticholinergics and/or antihistamines with anticholinergic effects at least 14 days
             prior to Day 1 (Visit 2)

          -  Subjects with a documented history of alcohol or substance abuse within the 12 months
             prior to randomization(consumption of >21 units of alcohol per week is considered
             alcohol abuse)

          -  Subjects with significant CNS effects including vertigo and dizziness
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.
Subject must be at most 80 Years

Eligibility (NLI label): Contradiction