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Acute Gout — MRCGP AKT MCQ

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EasyRheumatologyAcute GoutMRCGP AKTUKMLAPARAPSA

A 40-year-old man develops sudden severe pain, redness and swelling of his first metatarsophalangeal joint overnight. He is systemically well, and a clinical diagnosis of an acute gout flare is made. His serum urate concentration during the flare is 310 micromol/L. Which is the most appropriate pharmacological treatment of the current flare?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Offer a short course of low-dose oral colchicine

Explanation lettering: E = shown as A · A = shown as B · B = shown as D · D = shown as E

B is correct. Colchicine is an appropriate first-line anti-inflammatory treatment for an acute gout flare; an NSAID or a short course of oral corticosteroid may also be selected according to comorbidities, co-prescriptions and patient preference. A normal serum urate concentration during a flare does not exclude gout because the level can fall acutely; it should be repeated at least 2 weeks after the flare settles if diagnostic confirmation is required. Allopurinol and probenecid lower urate but do not provide adequate treatment of the current inflammation. Long-term NSAID monotherapy is not routine flare prevention. Oral corticosteroids are a valid alternative, but a fixed 40 mg course for 10 days should not be prescribed routinely without individualising dose, duration and risk.

Reference: National Institute for Health and Care Excellence. NG219: Gout—diagnosis and management, recommendations 1.1.7, 1.3.1 and 1.5.4. 2022. https://www.nice.org.uk/guidance/ng219/chapter/Recommendations