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Acute gout with NSAID contraindications — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsAcute gout with NSAID contraindicationsGPhC CRA

A 52-year-old man with gout and CKD stage 3 presents with an acute swollen first metatarsophalangeal joint. He takes ramipril and apixaban, and he previously had a peptic ulcer bleed. He asks to buy naproxen. What is the most appropriate alternative?

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Correct answer: C — Refer or liaise for colchicine if clinically suitable

Oral NSAIDs are high risk here because of CKD, anticoagulation and previous ulcer bleeding. Colchicine is often an alternative for acute gout if there are no contraindications and dosing is adjusted as needed. Starting allopurinol is not the immediate analgesic solution for this acute presentation.

Reference: BNF; NICE CKS