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Acute Gout Podagra — RACP Adult Medicine MCQ

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EasyRheumatologyAcute Gout PodagraRACP Adult Medicine

A 55-year-old man presents with an acutely hot swollen first metatarsophalangeal joint. This is his first episode. He has a history of hypertension treated with hydrochlorothiazide. Uric acid is 0.55 mmol/L. He drank heavily 2 days ago. What is the most likely diagnosis?

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Correct answer: D — Acute gout

Acute monoarthritis of the first MTP (podagra) with known risk factors (thiazide diuretic, alcohol binge, hyperuricaemia) is acute gout — the most common cause of acute monoarthritis. Serum uric acid may be NORMAL during an acute flare (30% of cases) due to uricosuric effect of acute inflammation. Joint aspiration showing MSU crystals is the gold standard. Treatment: colchicine, NSAIDs, or prednisolone.

Reference: eTG Rheumatology – 2024 – Gout; ARA 2024