Chronic tophaceous gout — SCE Rheumatology MCQ
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Correct answer: D — Start treat-to-target urate-lowering therapy with flare prophylaxis
Start treat-to-target urate-lowering therapy with flare prophylaxis is the single best answer because tophi and overhanging erosions indicate chronic tophaceous gout. The stem is testing management choice, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Septic arthritis is less suitable because it fits a different clinical pattern or a different treatment threshold; Reactive arthritis, Serum urate alone and Allopurinol during severe drug rash do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.
Reference: NICE NG219; BSR gout and hot swollen joint guidance; BNF