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Acute gout in chronic kidney disease — RACP Adult Medicine MCQ

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ModerateRheumatologyAcute gout in chronic kidney diseaseRACP Adult Medicine

A 69-year-old man with CKD stage 4 develops acute monoarthritis of the first MTP joint. He takes apixaban for atrial fibrillation and has a history of peptic ulcer bleeding. Joint aspirate shows negatively birefringent crystals and culture is pending. What is the most appropriate management?

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Correct answer: E — Use oral or intra-articular corticosteroid therapy while excluding infection

Corticosteroids are often safest for acute gout when NSAIDs and high-dose colchicine are limited by CKD, anticoagulation and ulcer history. Allopurinol lowers urate but does not treat acute inflammation as monotherapy. Stopping anticoagulation and withholding anti-inflammatory treatment does not address severe gout pain.

Reference: Therapeutic Guidelines (eTG) Rheumatology; AMH