A 30-year-old man with peptic ulcer disease suddenly develops pain, redness, and swelling of his right first metatarsophalangeal joint. There is no history of injury. Serum uric acid concentration is 8 mg/dL. Examination of joint aspirate shows birefringent crystals. Which of the following drugs is most appropriate to treat the acute symptoms in this patient?
1.Allopurinol
2.Colchicine
3.Morphine
4.Probenecid
5.Sulfinpyrazone
Correct answer
Colchicine
Colchicine is effective in acute gout. It inhibits polymerization of microtubules and leukocyte chemotaxis.
(A) Allopurinol, (D) probenecid, and (E) sulfinpyrazone should be avoided during an acute flair because rapid changes in serum uric acid concentrations can precipitate crystalization of uric acid. Allopurinol inhibits uric acid production by inhibiting xanthene oxidase and probenecid inhibits uric acid reabsorption in the kidney. Sulfinpyrazone’s mechanism of action is similar to probenecid.
Morphine is a nonspecific treatment choice for gout. Colchicine is a better first choice.