Gout — SCE Rheumatology MCQ

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EasyCrystal ArthropathiesGoutSCE Rheumatology

A 58-year-old man with hypertension develops sudden severe pain and swelling of the first MTP joint overnight. The joint is red, hot and exquisitely tender. Serum urate measured during the attack is 390 micromol/L. He is afebrile and has had two similar episodes. What is the most likely diagnosis?

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Reveal the answer and explanation

Correct answer: D — Gout

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

Gout is best because recurrent acute podagra is highly suggestive of gout even if serum urate is not markedly elevated during the flare. A is less suitable because PsA would have psoriasis, dactylitis or nail disease; B is less suitable because RA is persistent symmetric synovitis rather than abrupt podagra; C is less suitable because pseudogout more often affects knees or wrists in older patients; D is less suitable because septic arthritis must be considered but recurrent classic podagra without systemic features favours gout. Clinical pearl: serum urate can be normal during an acute gout flare.

Reference: NICE NG219; BSR gout guideline