Acute gout — MCCQE Part 1 MCQ

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HardJoint PainAcute goutMCCQE Part 1

A man with CKD has his third abrupt, self-limited episode of exquisitely tender first-MTP monoarthritis after alcohol intake. He is afebrile and well. What is the most likely diagnosis?

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Correct answer: E — Acute gout

Recurrent, abrupt, intensely inflammatory first-metatarsophalangeal arthritis is classic podagra, and chronic kidney disease plus alcohol exposure increase gout risk. Rheumatoid arthritis is usually persistent and polyarticular; osteoarthritis is more mechanical, plantar fasciitis affects the heel, and cellulitis is not centred within the joint. Nevertheless, gout and septic arthritis can coexist. A first, atypical or systemically ill presentation should prompt arthrocentesis for cell count, Gram stain, culture and crystal examination rather than relying on serum urate alone.

Reference: American College of Rheumatology, Gout Guideline, https://rheumatology.org/gout-guideline