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Gout — SCE Rheumatology MCQ

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EasyCrystal arthropathiesGoutSCE Rheumatology

A 38-year-old woman develops abrupt nocturnal first MTP pain and swelling. Examination shows the joint is hot, erythematous and exquisitely tender. Investigations show synovial fluid shows needle-shaped negatively birefringent crystals. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: D — Start allopurinol after flare settles

Start allopurinol after flare settles is the best answer because start allopurinol after flare settles is the most appropriate next step for gout in this clinical setting. Urgent antibiotics is a plausible distractor, but it does not account for the key discriminator in the stem. Oral prednisolone and Hydroxychloroquine would be more appropriate in a different clinical pattern or at another point in the pathway, while Intra-articular corticosteroid injection is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: NICE NG219; BSR hot swollen joint guideline; EULAR crystal arthropathy recommendations