Objective　To observe the clinical effect of small dose of colchicine combined with glucocorticoid for acute gouty arthritis. Methods　Ninety-two patients with acute gouty arthritis were equally and randomly divided into small doses of colchicine combined with dexamethasone treatment group (treatment group) and conventional large dose colchicine treatment group (control group) between January 2009 and December 2013. The articular lesion scoring and clinical efficacy evaluation were performed at 3, 6, 12, 24, 48, and 72h after treatment. Erythrocyte sedimentation rate (ESR), white blood cells, hepatorenal function and glomerular filtration rate (GFR) were determined before and 72h after treatment respectively. The gastrointestinal adverse events and recurrence rate were observed within one month after treatment. Results　The articular lesion scores were significantly decreased at 6, 12, 48, and 72h after treatment in treatment group compared with control group (P<0.05 or P<0.01). Compared with that of pre-treatment, ESR and white blood cell count were decreased significantly 72h after treatment (P<0.05), but there was no statistical difference between the two groups (P>0.05). Serum uric acid, glutamic-pyruvic transaminase in serum (SGPT), and GFR did not show any change before and 72h after the treatment, and there was also no significant difference between groups (P>0.05). The incidence of gastrointestinal adverse events were obviously higher in control group (76.1%) compared with that of the treatment group (P<0.05), and the differences was statistically significant. There was no statistical difference in recurrence rate between the control group and treatment group after a follow-up of one month. Conclusions　Compared with conventional large dose colchicine, small dose of colchicine combined with dexamethasone can more rapidly and effectively control acute gouty arthritis, with good tolerability and safety, thus being worthy of popularization clinically. DOI: 10.11855/j.issn.0577-7402.2015.08.10