Recommendation is to demonstrate crystals in joint aspirate. Urate crystals are rod or needle shaped and negatively birefringent. Crystals may be recovered from joints during asymptomatic periods. Examined fluid should be sent for Gram stain and culture to rule out infection. Serum uric acid levels are generally not helpful in acute attacks and may be normal.
Steroids are another option for acute treatment.
There is no advantage to using ketorolac in an acute flare of gout. It is equal to indomethacin in time of onset and control of symptoms. 30 to 60 mg IM, followed by 15 to 30 mg Q6-8h to maximum of 120 mg a day. PO with colchicine 0.5 mg PO once or twice a day until symptoms resolve. Administer 1 mg PO initially, followed by 0.5 mg Q2h up to 6 times on first day.