American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line treatment for acute gout?

1. Colchicine

2. NSAIDs

3. Allopurinol

4. Corticosteroids

The correct answer is: NSAIDs

The first-line treatment for acute gout is nonsteroidal anti-inflammatory drugs (NSAIDs). This approach is based on the mechanism of action of NSAIDs, which effectively reduce inflammation and pain associated with acute gout attacks. They work by inhibiting the cyclooxygenase (COX) enzymes involved in the inflammatory response, leading to decreased production of prostaglandins that mediate pain and swelling. When managing an acute attack of gout, NSAIDs are often preferred due to their rapid onset of action and the ability to provide symptomatic relief, allowing patients to return to their normal activities more quickly. Commonly used NSAIDs for this purpose include indomethacin, naproxen, and ibuprofen. Colchicine, while also effective for acute gout, is typically considered for patients who cannot take NSAIDs or in cases where NSAIDs are contraindicated. Allopurinol is used for long-term management of gout by lowering uric acid levels but is not indicated for treating acute attacks. Corticosteroids can be used when NSAIDs or colchicine are not appropriate, but they are not the first-line choice due to potential side effects and the effectiveness of NSAIDs in acute scenarios. Thus, the preference for NSAIDs simplifies and