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Acute Gout — RACP Adult Medicine MCQ

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EasyRheumatologyAcute GoutRACP Adult Medicine

A 55-year-old man presents with acute monoarthritis of the first MTP joint. The joint is erythematous, swollen, and exquisitely tender. Joint aspirate shows negatively birefringent needle-shaped crystals under polarised light microscopy. What is the most likely diagnosis?

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Correct answer: E — Gout

Acute first MTP joint monoarthritis (podagra) with negatively birefringent needle-shaped crystals on polarised microscopy is diagnostic of acute gout. First-line treatment is colchicine (within 12 hours of onset), NSAIDs, or corticosteroids. Urate-lowering therapy (allopurinol) should not be commenced during an acute flare.

Reference: ARA – 2024 – Gout Guidelines; eTG Rheumatology 2024