For acute gout or pseudogout presenting in the knee, what is the initial management?

• A. NSAIDs as first-line; colchicine if needed; joint aspiration to confirm; long-term urate or calcium pyrophosphate management as indicated
• B. Immediate antibiotics
• C. Corticosteroid injections without confirmation
• D. Bed rest without NSAIDs

Answer: (C)

The key idea is to rapidly control inflammation while making sure the joint isn’t infected. For an acute flare in the knee from gout or pseudogout, the first step is joint aspiration to analyze crystals and culture the fluid, so septic arthritis can be ruled out before starting definitive treatment. If infection is excluded, the anti-inflammatory approach starts with NSAIDs as first-line therapy. Colchicine is an option if NSAIDs are not suitable, and intra-articular corticosteroids can be used to control the flare after the joint has been aspirated or if NSAIDs are contraindicated. Giving corticosteroid injections without confirming there’s no infection is discouraged because it could mask an septic joint. Bed rest without NSAIDs isn’t appropriate, and antibiotics aren’t used unless there’s evidence of infection. Long-term management then focuses on addressing the underlying condition (urate-lowering therapy for gout or management of CPPD) as indicated.