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Gout — SCE Rheumatology MCQ

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ModerateCrystal arthropathiesGoutSCE Rheumatology

A 33-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 consultant wants the next test most likely to confirm the suspected process or guide treatment. The result will change diagnosis, staging or immediate treatment. What is the most appropriate investigation?

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Correct answer: B — Serum urate after the flare

Serum urate after the flare is the best answer because serum urate after the flare is the investigation most likely to resolve the immediate diagnostic or monitoring question in gout. Ultrasound-guided aspiration is a plausible distractor, but it does not account for the key discriminator in the stem. MRI scan and Calcium, phosphate and magnesium would be more appropriate in a different clinical pattern or at another point in the pathway, while Ultrasound double-contour assessment is suboptimal for this presentation. Clinical pearl: autoantibodies are supportive tests and should be interpreted alongside phenotype, inflammatory markers, urinalysis and imaging.

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