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Gout flare — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareGout flareUSMLE Step 3

A 58-year-old man has sudden severe pain and swelling of the first metatarsophalangeal joint. He has had two similar attacks in the past year. He takes hydrochlorothiazide. Temperature is 37.2°C. Arthrocentesis shows needle-shaped negatively birefringent crystals and no organisms. Which of the following is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Treat the acute flare with oral colchicine

Acute gout is treated with an anti-inflammatory agent such as colchicine, NSAID, or glucocorticoid; urate-lowering therapy is addressed after acute control and with flare prophylaxis.

Reference: American College of Rheumatology gout guideline: https://rheumatology.org/