Question

A 38-year-old man with a past medical history of hypertension and chronic kidney disease presents with severe left foot pain that began in the middle of the night. He appears comfortable but has exquisite tenderness to palpation of the left first metatarsophalangeal joint. The joint is erythematous and warm. His vital signs include a temperature of 99.1ºF, blood pressure of 132/85 mm Hg, respiratory rate of 16 breaths/minute, and oxygen saturation of 99% on room air. Arthrocentesis of the involved joint is performed, and synovial fluid analysis reveals negatively birefringent crystals. Which of the following is the most appropriate therapy at this time?

a) Allopurinol
b) Naproxen
c) Prednisone
d) Probenecid

Answer 1

The most appropriate therapy for an acute gout flare in a patient presenting with symptoms and synovial fluid analysis indicative of gout is naproxen, an NSAID.

Step-by-step explanation:

The presentation of severe left foot pain, exquisite tenderness at the first metatarsophalangeal joint, erythema, warmth, and the presence of negatively birefringent crystals in the synovial fluid are indicative of a gout flare. In treating an acute gout attack, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and colchicine are appropriate therapies. Naproxen is an NSAID and would be indicated in this scenario to provide pain relief and reduce inflammation. Allopurinol and probenecid are uric acid-lowering therapies used in the long-term management of gout to prevent attacks, not for acute treatment. Prednisone, a corticosteroid, could be used if NSAIDs are contraindicated. Therefore, the most appropriate initial therapy for this patient's acute gouty attack would be naproxen.