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Gout — SCE Rheumatology MCQ

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HardCrystal arthropathiesGoutSCE Rheumatology

Synovial fluid from an acutely inflamed first MTP joint shows needle-shaped negatively birefringent crystals. What is the most appropriate immediate management?

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Correct answer: DTreat the gout flare with an NSAID, colchicine or corticosteroid selected for comorbidity

The best answer is “Treat the gout flare with an NSAID, colchicine or corticosteroid selected for comorbidity”. Crystal-proven acute gout should be treated promptly with an anti-inflammatory option selected for kidney function, gastrointestinal risk and other comorbidity; further imaging is unnecessary to confirm the flare. The remaining choices—“Order dual-energy CT before treating, within a rheumatology pathway, after safety review”, “Start allopurinol as the sole acute analgesic, after safety review, after specialist assessment”, “Give long-term antibiotics, with clinical reassessment, after specialist assessment, with clinical reassessment”, “Immobilise the joint for six weeks, with clinical reassessment, within a rheumatology pathway”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG219 gout: https://www.nice.org.uk/guidance/ng219/chapter/Recommendations