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Chronic gout — SCE Rheumatology MCQ

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HardCrystal arthropathiesChronic goutSCE Rheumatology

A 62-year-old man with poorly controlled tophaceous gout has falling eGFR and recurrent renal colic. Examination shows tophi are present on both elbows. Investigations show serum urate is 650 micromol/L. What is the most important complication to screen for?

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Correct answer: C — Urate nephrolithiasis and chronic urate nephropathy

The best answer is “Urate nephrolithiasis and chronic urate nephropathy”. Urate nephrolithiasis and chronic urate nephropathy is supported by the cited UK or directly applicable specialist authority and best matches the tested threshold, complication or monitoring principle. The remaining choices—“Atlantoaxial subluxation, after safety review”, “Anterior uveitis, after specialist assessment”, “Pulmonary arterial hypertension, with clinical reassessment”, “Scleroderma renal crisis, after safety review”—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