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Gout flare — MCCQE Part 1 MCQ

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ModerateJoint PainGout flareMCCQE Part 1

A 52-year-old man wakes with severe pain, redness and swelling of the first metatarsophalangeal joint after a weekend of alcohol and rich food. He has no fever and no trauma. Which of the following is the most likely diagnosis?

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Correct answer: D — Acute gout flare

Podagra with abrupt intense inflammation is classic acute gout, although septic arthritis must be considered when fever or atypical features are present. Osteoarthritis is chronic and less inflammatory; rheumatoid arthritis is usually symmetric and polyarticular. Acute treatment may include NSAIDs, colchicine or corticosteroids depending comorbidities, with urate-lowering therapy addressed after the flare plan is clear.

Reference: Canadian Rheumatology Association gout management recommendations