A 50-year-old man presents to the emergency department with acute severe pain, swelling, and redness of the first MTP joint. Serum uric acid is 10.2 mg/dL. Synovial fluid shows negatively birefringent needle-shaped crystals under polarised light. During this acute attack, the drug most rapidly effective in providing pain relief and anti-inflammatory action is:

• A Allopurinol — start immediately to reduce urate levels
• B Colchicine within 12 hours of attack onset ✓
• C Probenecid as a uricosuric agent
• D Febuxostat for acute urate-lowering

Explanation

Colchicine is the drug of choice for acute gout when given within 12 hours of attack onset; it works by inhibiting microtubule polymerisation in neutrophils, blocking their migration into the joint and the NLRP3 inflammasome activation responsible for IL-1β release. NSAIDs are equally effective if colchicine is contraindicated or delayed. Critically, allopurinol (A) and febuxostat (D) — urate-lowering therapies — should NEVER be started during an acute attack as they can worsen or prolong the flare by mobilising urate crystal deposits; they are initiated 2–4 weeks after the acute attack resolves.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.