Acute gout flares account for a substantial number of visits to the emergency department (ED). Treatment of the acute gout flare in the ED was the subject of an interesting article by Dalal DS et al.. The authors reported that 28.3% of the 456 patients included in the study received an opioid at discharge. Furthermore, 80% of the opioid prescriptions were new, indicating a large proportion of patients without previous exposure to an opioid were now exposed. We reported on the diagnosis and treatment of acute gout flares in a large series of 541 consecutive ED visits over a 7-year period (3).