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Gout — SCE Rheumatology MCQ

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EasyCrystal arthropathiesGoutSCE Rheumatology

A 63-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: B — NSAID therapy with gastroprotection

NSAID therapy with gastroprotection is the best answer because nsaid therapy with gastroprotection is the most appropriate next step for gout in this clinical setting. Therapeutic exercise is a plausible distractor, but it does not account for the key discriminator in the stem. Mycophenolate mofetil and Lifestyle advice and follow-up would be more appropriate in a different clinical pattern or at another point in the pathway, while Colchicine 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