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IL-1 Inhibition in Gout — SCE Rheumatology MCQ

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ModerateCrystal ArthropathyIL-1 Inhibition in GoutSCE Rheumatology

A 60-year-old man has crystal-proven gout and a severe acute polyarticular flare. NSAIDs are contraindicated, colchicine previously caused neuromyopathy, and an adequate course of corticosteroids has been ineffective. Rheumatology review is arranged. Which statement best reflects current NICE guidance on the use of an IL-1 inhibitor such as anakinra?

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

Reveal the answer and explanation

Correct answer: B — Consider an IL-1 inhibitor for an acute flare when NSAIDs, colchicine and corticosteroids are contraindicated, not tolerated or ineffective, after rheumatology referral

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

C is correct. NICE reserves IL-1 inhibition for exceptional acute gout flares in which NSAIDs, colchicine and corticosteroids are all contraindicated, not tolerated or ineffective, and recommends rheumatology referral before prescribing. The stem establishes failure or inability to use each standard treatment. IL-1 inhibitors are therefore not preferred merely because chronic kidney disease is present (A), and they are not routine first-line flare therapy (E). NICE also restricts their use for prophylaxis during initiation or titration of urate-lowering therapy to patients unable to use colchicine, NSAIDs and corticosteroids, so B is too broad. D is incorrect because IL-1 blockade can suppress crystal-induced inflammation. Anakinra may be used by specialists but is off-label for gout in the UK; canakinumab has a licensed gout indication.

Reference: NICE. Gout: diagnosis and management (NG219), section 1.3, recommendation 1.3.4. 2022. https://www.nice.org.uk/guidance/ng219/chapter/Recommendations