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Gout with CKD — SCE Rheumatology MCQ

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ModerateCrystal ArthropathiesGout with CKDSCE Rheumatology

A 71-year-old man with gout has an acute wrist flare. He has CKD stage 4, heart failure and previous NSAID-related gastrointestinal bleeding. Synovial fluid previously showed monosodium urate crystals and there is no fever. The flare started yesterday. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Use oral or intra-articular corticosteroid depending on joint assessment

Explanation lettering: D = shown as C · C = shown as D

Use oral or intra-articular corticosteroid depending on joint assessment is best because corticosteroids are suitable for acute gout when NSAIDs and colchicine are limited by renal disease and comorbidity. A is less suitable because methotrexate does not treat gout flare; B is less suitable because ciprofloxacin is not gout treatment; C is less suitable because high-dose ibuprofen is unsafe with CKD, heart failure and GI bleed history; E is less suitable because probenecid is ineffective in significant renal impairment and is not acute flare therapy. Clinical pearl: renal function and cardiovascular risk often decide acute gout therapy.

Reference: NICE NG219; BNF