Paper I
2022 July (Supplementary) (2019 Scheme) · 100 marks · 180 min

Question

Treatment of Acute attack of gout

Q114 marksShort Answers

Answer

  • NSAIDs (Indomethacin, Naproxen) — first-line, provide rapid anti-inflammatory relief; avoided in renal impairment/peptic ulcer disease.
  • Colchicine — inhibits neutrophil microtubule polymerization and migration into the joint, reducing the inflammatory response to deposited urate crystals; an alternative when NSAIDs are contraindicated, though with a narrower therapeutic margin (GI adverse effects common).
  • Corticosteroids (oral or intra-articular) — used when NSAIDs/colchicine are contraindicated or ineffective, particularly in patients with renal impairment or multiple comorbidities.

Important principle: urate-lowering therapy (Allopurinol, Febuxostat) is not started during an acute attack — initiating it can mobilize urate crystals and actually worsen/prolong the attack; it is reserved for interval (prophylactic) therapy once the acute attack has resolved.

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