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Gout — SCE Rheumatology MCQ

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EasyCrystal arthropathiesGoutSCE Rheumatology

A 74-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: C — Oral prednisolone

Oral prednisolone is the best answer because oral prednisolone is the most appropriate next step for gout in this clinical setting. Start allopurinol after flare settles is a plausible distractor, but it does not account for the key discriminator in the stem. NSAID therapy with gastroprotection and Mycophenolate mofetil would be more appropriate in a different clinical pattern or at another point in the pathway, while Increase urate-lowering therapy gradually 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