Acute Gout Treatment — SCE Rheumatology MCQ

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ModerateCrystal ArthropathyAcute Gout TreatmentSCE Rheumatology

A 65-year-old man presents with acute gout of the first MTP joint. He has an eGFR of 55 mL/min and takes Aspirin 75 mg daily for cardiovascular prophylaxis. He has a history of peptic ulcer. Which acute treatment is most appropriate?

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Correct answer: A — Oral Prednisolone 30 mg daily for 5 days

With peptic ulcer history (contraindicating NSAIDs) and CKD stage 3 (requiring Colchicine dose caution) oral Prednisolone is the most appropriate option. NICE 2022 gout guidelines recommend NSAIDs Colchicine or a short course of oral corticosteroid as first-line options for acute gout flares taking comorbidities into account. This patient's peptic ulcer history makes NSAIDs inadvisable and renal impairment increases Colchicine toxicity risk. Short-course oral Prednisolone (20-30 mg daily for 5-7 days) provides effective anti-inflammatory relief.

Reference: NICE NG219 (2022) gout guidelines; BSR 2017 gout guidelines