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Gout Flare-Management — SCE Rheumatology MCQ

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EasyRheumatologyGout Flare-ManagementSCE Rheumatology

A 65-year-old woman taking hydrochlorothiazide presents with acute severe pain, erythema and swelling of the first metatarsophalangeal joint. Synovial fluid contains needle-shaped, negatively birefringent crystals; Gram stain is negative. She has normal renal function and no contraindication to standard anti-inflammatory treatment. What is the most appropriate immediate management?

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Correct answer: E — Give an NSAID, colchicine, or a short course of oral corticosteroid

This is a crystal-confirmed acute gout flare. NICE recommends an NSAID, colchicine or a short course of oral corticosteroid as first-line treatment, selected according to comorbidities, co-prescriptions and patient preference. Allopurinol and probenecid are urate-lowering treatments and do not provide adequate treatment for the acute inflammation when used alone. High-dose aspirin is inappropriate because salicylates affect renal urate handling and are not recommended for gout flares. The negative Gram stain and identification of monosodium urate crystals, together with the clinical context, make empirical antibiotics inappropriate. Hydrochlorothiazide and the need for longer-term urate-lowering therapy should be reviewed separately after controlling the acute flare.

Reference: National Institute for Health and Care Excellence. Gout: diagnosis and management (NG219), section 1.3, Managing gout flares. 2022. https://www.nice.org.uk/guidance/ng219/chapter/Recommendations