Gout: The Daily PANCE Blueprint

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Gout: The Daily PANCE Blueprint

A 58-year-old man with hypertension and stage 3 chronic kidney disease wakes with an exquisitely painful, red, swollen, warm first metatarsophalangeal joint. Arthrocentesis shows needle-shaped, negatively birefringent crystals. Given his renal impairment, which is the most appropriate first-line treatment for this acute flare?

A. High-dose indomethacin (NSAID)
B. Allopurinol
C. Probenecid
D. Oral prednisone (glucocorticoid)
E. Febuxostat

Answer and topic summary

The answer is D. Oral prednisone (glucocorticoid).

Acute gout flares can be treated with NSAIDs, colchicine, OR glucocorticoids — but in chronic kidney disease, NSAIDs are best avoided and colchicine needs renal dose-adjustment, so a short oral glucocorticoid course is the safest first-line choice. Urate-lowering agents (allopurinol, febuxostat, probenecid) are for chronic management and are NOT started during an acute flare (continue them if the patient is already taking one). The crystals of gout are needle-shaped and negatively birefringent.

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Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Rheumatologic Conditions ⇒ Gout and pseudogout

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