A patient on sitagliptin (DPP-4 inhibitor) develops an acute flare of joint pain. The MOST likely adverse effect is:

• A Drug-induced pseudogout due to pyrophosphate deposition
• B Gout flare due to uric acid retention from renal URAT1 inhibition
• C Gliptin-associated arthralgia — a recognised class effect of DPP-4 inhibitors ✓
• D Reactive arthritis from DPP-4-mediated immune modulation

Explanation

Severe joint pain (arthralgia) is a recognised class effect of DPP-4 inhibitors (gliptins), documented in FDA and DCGI warnings. It can occur months to years after starting therapy and is reversible upon discontinuation. The mechanism relates to DPP-4 being expressed on synoviocytes and immune cells, affecting peptide substrates that modulate inflammation. This is not gout or pseudogout; URAT1 inhibition causing hyperuricaemia is the mechanism of SGLT2 inhibitors (which actually lower urate) or probenecid.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.