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Suspected gout with atypical site — SCE Rheumatology MCQ

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HardCrystal arthropathiesSuspected gout with atypical siteSCE Rheumatology

A 52-year-old woman has recurrent midfoot attacks but no aspiratable effusion today. Examination shows examination between attacks is normal. Investigations show serum urate is intermittently high. What is the most appropriate investigation?

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Correct answer: E — Ultrasound or dual-energy CT for urate deposition

The best answer is “Ultrasound or dual-energy CT for urate deposition”. Ultrasound or dual-energy CT for urate deposition most directly resolves the diagnostic or staging uncertainty at this point in the pathway; the other investigations answer different questions or have lower yield. The remaining choices—“Renal biopsy, after safety review, after safety review”, “Anti-centromere antibody, with clinical reassessment, after specialist assessment”, “Temporal artery biopsy, within a rheumatology pathway”, “Schirmer test, after safety review, within a rheumatology pathway”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG219 gout: https://www.nice.org.uk/guidance/ng219/chapter/Recommendations