A 52-year-old has tophaceous gout and three attacks in the past year. eGFR is 48 mL/min/1.73 m². Best long-term management strategy?...

Question

A 52-year-old has tophaceous gout and three attacks in the past year. eGFR is 48 mL/min/1.73 m². Best long-term management strategy?

Accepted Answer

Start allopurinol at ≤100 mg/day (lower if advanced CKD), titrate to serum urate

Answer

Start probenecid.

Answer

Continue NSAIDs as needed only; defer urate-lowering therapy (ULT).

Answer

Start febuxostat as first-line ULT.

Answer

Avoid initiating ULT during an acute flare under all circumstances.

us-usmle-step-2 MCQ (SBA): Gout