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Gout flare with anticoagulation — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsGout flare with anticoagulationGPhC CRA

A 63-year-old man with AF on apixaban 5mg twice daily asks for ibuprofen for a hot swollen first metatarsophalangeal joint that began yesterday. He has CKD stage 3a and a history of peptic ulcer. He is not taking urate-lowering therapy. What is the most appropriate alternative?

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Correct answer: D — Refer for assessment and consider colchicine suitability with prescriber input

NSAIDs would be high risk because of apixaban, CKD and previous peptic ulcer. Colchicine may be an option but requires attention to renal function, interactions and dose. Starting allopurinol as a pharmacy substitution is inappropriate, and stopping anticoagulation without prescriber input is unsafe. The patient needs prompt clinical management of the flare.

Reference: NICE CKS Gout; BNF