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Gout flare with chronic kidney disease — SCE Rheumatology MCQ

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HardCrystal arthropathiesGout flare with chronic kidney diseaseSCE Rheumatology

A 76-year-old man with stage 4 chronic kidney disease presents with a hot swollen first MTP joint. He takes apixaban for atrial fibrillation and has previous peptic ulcer bleeding. Synovial fluid shows negatively birefringent needle-shaped crystals and Gram stain is negative. What is the most appropriate management of the flare?

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Correct answer: B — Oral or intra-articular corticosteroid depending on joint accessibility

Acute gout flare treatment should account for comorbidities; NSAIDs are poor choices with advanced CKD, anticoagulation and ulcer history, and high-dose colchicine is unsafe. Corticosteroid treatment is appropriate once infection is not suspected. Urate-lowering therapy prevents future flares but does not treat the acute flare by itself.

Reference: NICE NG219; BSR gout guideline