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Gout diagnosis during flare — SCE Rheumatology MCQ

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EasyCrystal ArthropathiesGout diagnosis during flareSCE Rheumatology

A 52-year-old man has suspected gout affecting the first MTP joint. Serum urate checked during the flare is 330 micromol/L, but clinical suspicion remains high. The pain settles after naproxen. He asks whether gout has been excluded. What is the most appropriate investigation?

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Correct answer: D — Repeat serum urate after the flare has settled

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · C = shown as D · A = shown as E

Repeat serum urate after the flare has settled is best because serum urate can fall during an acute flare, so repeat testing after recovery is appropriate if aspiration was not performed. A is less suitable because normal urate during a flare does not exclude gout; B is less suitable because rituximab is not a gout treatment; D is less suitable because anti-Ro evaluates Sjögren/SLE phenotypes; E is less suitable because temporal artery biopsy is for GCA. Clinical pearl: biochemical confirmation is best made away from the acute inflammatory episode.

Reference: NICE NG219