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Gout — MCCQE Part 1 MCQ

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EasyJoint PainGoutMCCQE Part 1

50-year-old man presents with sudden severe first MTP pain. The joint is red, hot and exquisitely tender after beer and seafood intake. Which of the following is the most appropriate next step?

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Correct answer: D — Treat acute gout with NSAID/colchicine if safe and address urate-lowering later

Treat acute gout with NSAID/colchicine if safe and address urate-lowering later is best because podagra is classic for acute gout. Treat with topical therapy only despite systemic or red-flag features is suboptimal because local treatment alone is inadequate when systemic disease is possible; Delay assessment for several months is suboptimal because red-flag musculoskeletal or dermatologic presentations require timely assessment; Use antibiotics for every presentation is suboptimal because many rashes and painful joints are inflammatory, malignant or mechanical rather than bacterial; Provide opioids or reassurance as the sole management is suboptimal because symptom relief alone does not address diagnosis, function or safety. Do not start urate-lowering therapy as the sole acute treatment.

Reference: Canadian Rheumatology Association gout guidance