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Mixed Crystal Arthropathy — SCE Rheumatology MCQ

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HardCrystal ArthropathyMixed Crystal ArthropathySCE Rheumatology

A patient with acute CPP crystal arthritis has stage 4 chronic kidney disease and takes clarithromycin for pneumonia. Which prescribing issue makes standard colchicine treatment unsafe?

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Correct answer: D — Impaired colchicine clearance plus CYP3A4 and P-glycoprotein inhibition

The best answer is “Impaired colchicine clearance plus CYP3A4 and P-glycoprotein inhibition”. Kidney failure reduces colchicine elimination, while clarithromycin inhibits major metabolic and transport pathways and can produce life-threatening colchicine toxicity. The interaction does not accelerate clearance, impair antibiotic absorption, inactivate colchicine or change the crystal species.

Reference: NICE CKS gout treatment guidance: https://cks.nice.org.uk/topics/gout/