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Acute gout flare — SCE Rheumatology MCQ

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ModerateCrystal arthropathiesAcute gout flareSCE Rheumatology

A 60-year-old man with CKD stage 4 has an acute gout flare in the wrist. Examination shows the joint is hot and aspiration confirms urate crystals. Investigations show eGFR is 24 mL/min/1.73m2 and there is no sepsis. What is the most appropriate management?

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Correct answer: D — Oral corticosteroid

Oral corticosteroid is the most appropriate management because it matches the crystal diagnosis, comorbidity and infection risk. The tempting alternatives either ignore renal or drug safety, fail to lower urate long term, or delay septic arthritis treatment. Crystal arthritis care separates acute anti-inflammatory treatment from long-term urate-lowering strategy.

Reference: NICE NG219; BSR gout guideline; EULAR CPPD recommendations; BNF