Question

A 63-year-old man presents to your clinic complaining of excruciating pain in his left big toe. After being diagnosed with an acute gout flare, his physician wants to start him on therapy. His medical history is positive for hypertension, hyperlipidemia, peptic ulcer disease, and glaucoma. Which of the following is the most appropriate therapy at this time for the patient?

A. Ibuprofen
B. Indomethacin
C. Allopurinol
D. Prednisone
E. Krystexxa

Answer 1

Prednisone is the most appropriate therapy for a 63-year-old man with hypertension, hyperlipidemia, peptic ulcer disease, and glaucoma experiencing an acute gout flare, due to his medical history making some common treatments for gout contraindicated.

Step-by-step explanation:

A 63-year-old man with a medical history of hypertension, hyperlipidemia, peptic ulcer disease, and glaucoma is experiencing an acute gout flare characterized by excruciating pain in his left big toe. Considering this medical history, the appropriate treatment at this time would be D. Prednisone.

Nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen and Indomethacin may be contraindicated due to his peptic ulcer disease, Allopurinol is typically used for chronic management of gout rather than acute flares, and Krystexxa (pegloticase) is used for chronic gout that is refractory to other treatments, making Prednisone the safer choice given his comorbid conditions. Gout is caused by the accumulation of uric acid crystals in the joints, leading to intense inflammation and pain, as illustrated in Figure 25.4.2.