]> 2026-07-31T16:29:01+00:00 WBR0240 0 en Nutritional and lifestyle strategies '''Incorrect''' : In patients presenting with gouty arthritis and normal renal function but without visible or palpable tophaceous deposits or radiographic evidence of joint destruction or bony erosions, it should be possible to manage their disease successfully with life-style modifications, combined when necessary with pharmacologic therapy. Advice NSAIDs on every attack Start him on Allopurinol after 2 weeks Start him on Allopurinol immediately '''Incorrect''' : It has long been advocated that urate-lowering therapy should not be initiated until after an acute gout flare has resolved, and we wait at least two weeks after an acute flare has subsided to initiate urate-lowering medication. Start him on methotrexate Emergency Room A 56 year old man comes to the emergency department with severe pain in the right great toe. He says that this is the first time he is experiencing such a severe pain and it started suddenly when he woke up from his bed this morning. He is a chronic alcoholic and smokes 2 packs of cigarette a day. He denies any trauma to his leg. On examination, his right toe is swollen, erythematous and he did not allow touching because of severe pain. The diagnosis of acute gout is made by visualization of urate crystals in a sample of fluid aspirated from an affected joint (or bursa). The patient feels better after treatment with anti-inflammatory agents. What is the most appropriate line of management of the patient at this stage? C Musculoskeletal/Rheumatology 2020-10-27T23:52:11Z 2459150.4945718 WBR0240