Question

a 50 - year - old male presents with sudden onset severe pain and swelling in his left big toe joint. he denies any recent trauma but admits to consuming large quantities of red meat, shellfish, and beer over the weekend. laboratory investigations reveal elevated serum uric acid levels. what is the most appropriate initial management for this patient?
a allopurinol
b nsaids (nonsteroidal anti - inflammatory drugs)
c colchicine
d corticosteroids

Explanation:

The patient presents with sudden - onset severe pain and swelling in the big toe joint (a classic site for gout), a history of purine - rich food and alcohol intake (which can trigger gout), and elevated serum uric acid levels. In the acute management of gout:

• Allopurinol (A) is a urate - lowering therapy. However, it is not used in the acute phase as it can potentially worsen the acute gouty attack.
• NSAIDs (B) are a first - line treatment for acute gout. They work by inhibiting cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis, and thus decreasing inflammation and pain.
• Colchicine (C) can also be used for acute gout. It inhibits microtubule polymerization, which is important in the migration and activation of neutrophils (a key cell type in the inflammatory process of gout). But it has a relatively narrow therapeutic index and more side - effects compared to NSAIDs in many cases.
• Corticosteroids (D) are an option, especially if the patient cannot tolerate NSAIDs or colchicine. But NSAIDs are usually the initial choice unless there are contraindications (e.g., renal failure, peptic ulcer disease).

Answer:

B. NSAIDs (Nonsteroidal anti - inflammatory drugs)