What is the best treatment for a patient with acute gout who has chronic kidney disease?

For a patient with acute gout who also has chronic kidney disease, intraarticular steroid injection emerges as the best treatment option. This is primarily because intraarticular corticosteroids effectively control inflammation and pain associated with an acute gout attack without the systemic side effects commonly associated with oral medications.

Oral NSAIDs, while often effective for treating acute gout, pose a risk for patients with chronic kidney disease due to their potential to worsen renal function and increase the risk of gastrointestinal bleeding. Thus, they are generally avoided in this population.

Colchicine therapy is another option for gout treatment, but in patients with compromised kidney function, its use can be limited due to the risk of toxicity, as the drug is primarily eliminated by the kidneys. This makes it less ideal compared to the intraarticular approach.

Joint aspiration, although useful for both diagnostic and therapeutic purposes, may not provide the same rapid relief of symptoms as corticosteroid injection. In cases of significant swelling, aspiration may also be complicated and would not address the underlying inflammation as effectively as steroid administration can.

Thus, the use of intraarticular steroids is favored in managing gout flares in patients with chronic kidney disease due to its efficacy, lower risk of systemic side effects, and quicker relief of acute symptoms.