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Gout — SCE Rheumatology MCQ

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HardCrystal ArthropathiesGoutSCE Rheumatology

A 28-year-old woman has abrupt overnight first MTP pain, erythema, CKD, thiazide use and needle-shaped negatively birefringent crystals in synovial fluid. What is the most appropriate management?

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Correct answer: D — Treat the flare with NSAID, colchicine or corticosteroid chosen to comorbidity

The best answer is “Treat the flare with NSAID, colchicine or corticosteroid chosen to comorbidity”. Treat the flare with NSAID, colchicine or corticosteroid chosen to comorbidity is the most appropriate next step after the disease phenotype, previous treatment and safety constraints in the stem are considered. The remaining choices—“Septic arthritis, with clinical reassessment, after specialist assessment, with clinical reassessment”, “Reactive arthritis, within a rheumatology pathway, with clinical reassessment, within a rheumatology pathway”, “Serum urate alone, after safety review, within a rheumatology pathway”, “Allopurinol during severe drug rash, after safety review, after specialist assessment”—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: British Society for Rheumatology clinical guidelines: https://academic.oup.com/rheumatology/pages/clinical-guidelines