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Acute gout in advanced chronic kidney disease — SCE Acute Medicine MCQ

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ModerateMusculoskeletal SystemAcute gout in advanced chronic kidney diseaseSCE Acute Medicine

A 55-year-old man presents with severe pain and swelling of the first metatarsophalangeal joint. He has chronic kidney disease stage 4 and takes apixaban for atrial fibrillation. He is afebrile and joint aspirate shows negatively birefringent needle-shaped crystals with no organisms on Gram stain. What is the most appropriate acute treatment?

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Correct answer: D — Use oral or intra-articular corticosteroid after excluding infection

The aspirate confirms gout and infection has been assessed, while CKD and anticoagulation make NSAIDs less suitable. Corticosteroid treatment is often appropriate in this scenario. Allopurinol is for urate lowering and is not a rapid analgesic loading treatment. Colchicine requires caution and dose adjustment in renal impairment.

Reference: NICE NG219, BNF