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Gout — SCE Rheumatology MCQ

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ModerateCrystal ArthropathyGoutSCE Rheumatology

A 48-year-old man presents with recurrent gout attacks despite Allopurinol 300 mg daily. His serum urate remains at 440 micromol/L. He has normal renal function. What is the most appropriate next step?

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Correct answer: B — Increase Allopurinol dose titrating towards urate target

Allopurinol should be uptitrated in 100 mg increments (maximum 900 mg daily) to achieve the serum urate target. BSR guidelines emphasise a treat-to-target strategy. Many patients are undertreated because the dose is not titrated above 300 mg. Dose increases should be accompanied by monitoring of renal function and liver enzymes. Switching to Febuxostat is appropriate if the maximum tolerated Allopurinol dose fails to achieve target. Adding Colchicine provides prophylaxis against flares during uptitration but does not lower urate.

Reference: BSR 2017 - Guidelines for management of gout