Acute gout — SCE Rheumatology MCQ

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EasyCrystal ArthropathiesAcute goutSCE Rheumatology

A 62-year-old man has an acute gout flare in the ankle. He has eGFR 82 mL/min/1.73 m², no peptic ulcer disease and no anticoagulant use. He has no fever and septic arthritis is considered unlikely. Pain started 18 hours ago. What is the most appropriate management?

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Reveal the answer and explanation

Correct answer: A — Start an NSAID with gastroprotection as appropriate

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

Start an NSAID with gastroprotection as appropriate is best because NSAIDs are an appropriate first-line option for acute gout flare when not contraindicated. A is less suitable because methotrexate is a DMARD for inflammatory arthritis rather than gout flare; B is less suitable because arthroplasty is not an acute gout treatment; C is less suitable because allopurinol lowers urate long term but does not provide rapid flare control as sole therapy; E is less suitable because antibiotics are not indicated without infection. Clinical pearl: acute flare management and urate-lowering strategy are related but separate decisions.

Reference: NICE NG219; BNF