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MediumRheumatologyGoutau-amcau-racgp

A 42-year-old man presents with recurrent painful swelling of the first metatarsophalangeal joint. Joint aspiration during an acute attack previously demonstrated negatively birefringent monosodium urate crystals. He has no tophi. According to Australian gout management principles, when is it most appropriate to start allopurinol for long-term urate lowering?

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