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Acute gout with anticoagulation — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsAcute gout with anticoagulationGPhC CRA

A 61-year-old man asks to buy ibuprofen for a painful swollen first metatarsophalangeal joint that started overnight. He takes apixaban 5mg twice daily for atrial fibrillation and has a history of peptic ulcer bleeding. His temperature is 36.8C and he can weight-bear with difficulty. What is the most appropriate action?

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

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Correct answer: A — refer for same-day clinical assessment and avoid OTC NSAID supply

The presentation is compatible with acute gout, but OTC NSAID supply is inappropriate because apixaban and previous ulcer bleeding substantially increase bleeding risk. The patient needs clinical assessment for diagnosis and a safer treatment plan, such as colchicine or corticosteroid depending on suitability. Aspirin is not an appropriate analgesic choice in gout and adds bleeding risk. Allopurinol is not initiated by community supply for an acute undiagnosed flare.

Reference: BNF; NICE CKS: Gout