Question

A 50 year old patient wakes up with excruciating pain at the base of the great toe with redness and swelling. Which would be the most desirable drug?

• A. Allopurinol
• B. Probenecid
• C. Sulfinpyrazone
• D. Indomethacin

Hint:

Think about whether this drug treats the acute attack or lowers uric acid for the long run.

Answer 1

The Correct Option is D

Sudden pain, redness, and swelling at the big toe is the classic picture of acute gout. We need the best drug to use right now.

1. Allopurinol: Lowers uric acid production for the long term, but starting it during an active attack can stir up crystals and make pain worse. Not for now.
2. Probenecid: Helps the kidneys flush out more uric acid, again a long term control drug. Starting it mid attack carries the same risk of flaring the pain.
3. Sulfinpyrazone: Works the same way as probenecid, useful for prevention later, risky if started during the acute attack.
4. Indomethacin: A strong anti inflammatory that calms the joint fast without touching uric acid levels, exactly what an acute attack needs.

The other three drugs are for long term uric acid control and can even worsen an acute attack if started too soon, so indomethacin, an anti inflammatory, is the safe and effective choice right now.

Let's summarize:

• Acute gout needs fast anti inflammatory relief, not a change in uric acid levels.
• Urate lowering drugs like allopurinol, probenecid, and sulfinpyrazone are for later, after the attack settles.

So indomethacin is the most desirable drug here.