We report on a 28-year-old man with hematemesis, renal dysfunction, and arterial hypertension who suffered from an acute gouty attack presenting as podagra. Because of the accompanying symptoms conventional treatment of the gouty attack with colchicine or nonsteroidal anti-inflammatory drugs was contraindicated. We treated the pain of acute arthritis with the specific 5-hydroxytryptamine subtype 3 receptor antagonist ondansetron. Within 30 min after intravenous injection of this drug a substantial degree of pain relief had occurred. Unwanted side effects due to treatment were not observed. It is suggested that the 5-hydroxytryptamine released during a gouty attack induces pain via activation of 5-hydroxytryptamine subtype 3 receptors on nociceptive afferent nerve fibers. 5-Hydroxytryptamine subtype 3 receptor antagonists may therefore be a novel class of drugs for the effective treatment of acute gouty attacks when conventional treatment is contraindicated.