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Acute gout flare in advanced chronic kidney disease — SCE Acute Medicine MCQ

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ModerateMusculoskeletal systemAcute gout flare in advanced chronic kidney diseaseSCE Acute Medicine

A 74-year-old woman with CKD stage 4 presents with a first metatarsophalangeal joint flare. The joint is red and exquisitely tender, she is afebrile and CRP is mildly raised. She takes apixaban for atrial fibrillation and has peptic ulcer disease. What is the most appropriate treatment?

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Correct answer: D — Use low-dose colchicine or corticosteroid after assessing contraindications

Acute gout in advanced CKD and anticoagulation makes NSAIDs hazardous; low-dose colchicine or corticosteroid is usually preferred after reviewing interactions and renal dosing. Allopurinol is urate-lowering therapy and is not adequate analgesia for an acute flare. The pearl is to treat pain safely while planning urate-lowering strategy after the acute episode.

Reference: NICE NG219 gout; BNF colchicine