MKSAP: 55-year-old man with gout

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated during a follow-up visit for gout. Two years ago, he had been treated with allopurinol and developed a hypersensitivity reaction. Over the past several months, he has had recurrent attacks of acute, episodic swelling of the first metatarsophalangeal joints with increasing involvement of other joints, including the ankles and knees. Laboratory studies showed significant hyperuricemia. History is also significant for Crohn disease, hypertension, chronic kidney disease (estimated glomerular filtration rate of 55 mL/min/1.73 m2), and nonalcoholic fatty liver disease. Current medications are diltiazem and azathioprine, which he has been taking for the past 9 months. On physical examination, temperature is 37.1 °C (98.8 °F), blood pressure is 125/70 mm Hg, pulse rate is 80/min, and respiration rate is 12/min. BMI is 28. The examination is unremarkable, including no joint abnormalities. Which of the following is a contraindication to the use of febuxostat in this patient? A. Azathioprine B. Diltiazem C. Mild to moderate chronic kidney disease D. Nonalcoholic fatty liver disease Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Rheumatology Source Type: blogs