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Acute gout — RACGP Fellowship MCQ

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HardMusculoskeletal and sportsAcute goutRACGP Fellowship

A 60-year-old man develops a hot, swollen first metatarsophalangeal joint overnight. He has CKD stage 3b and takes apixaban for atrial fibrillation. Temperature is 37.7 °C and serum urate is 0.43 mmol/L. Which approach is most appropriate?

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Correct answer: E — Assess for septic arthritis and use corticosteroid-based flare treatment

E is correct. Acute gout remains plausible because serum urate can be misleading during a flare; infection must be considered and aspiration used when clinically indicated. CKD and apixaban make an NSAID a poor choice, so oral or intra-articular corticosteroid treatment is often safer once sepsis is sufficiently excluded. A creates renal and bleeding risk despite the renal check. B delays treatment and misuses serum urate as a diagnostic arbiter. C is urate-lowering rather than adequate anti-inflammatory monotherapy for this attack. D risks colchicine toxicity and delays aspiration when septic arthritis remains plausible.

Reference: Australian Prescriber: The management of gout: https://australianprescriber.tg.org.au/articles/the-management-of-gout.html