A 50-year-old man presents with acute monoarthritis of the first metatarsophalangeal joint with severe redness, swelling, and tenderness. Serum uric acid is 9.2 mg/dL. Joint fluid microscopy shows negatively birefringent needle-shaped crystals. The most appropriate acute treatment is:
- A Allopurinol 300 mg daily started immediately
- B Colchicine or NSAIDs for the acute attack ✓
- C Joint aspiration and intra-articular corticosteroid injection
- D Low-purine diet alone
Correct answer: B. Colchicine or NSAIDs for the acute attack
Explanation
Acute gouty arthritis is treated with colchicine, NSAIDs, or corticosteroids to reduce inflammation. Allopurinol (a xanthine oxidase inhibitor that lowers uric acid) should never be started during an acute attack, as sudden changes in uric acid levels can prolong or trigger new attacks; it is started 4–6 weeks after the attack resolves. Negatively birefringent needle-shaped monosodium urate crystals are pathognomonic of gout on polarised microscopy.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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