Gout — SCE Rheumatology MCQ

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EasyCrystal ArthropathyGoutSCE Rheumatology

A 58-year-old woman taking bendroflumethiazide for hypertension has experienced three gout flares in the past 12 months. Her serum urate is 510 micromol/L. She has no tophi or chronic gouty arthritis and is not currently receiving urate-lowering therapy. According to NICE NG219, what serum urate target should initially be used when titrating urate-lowering therapy?

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Correct answer: B — Below 360 micromol/L

The correct answer is B: below 360 micromol/L. NICE recommends a treat-to-target urate-lowering strategy with an initial serum urate target below 360 micromol/L. Her recurrent flares and diuretic treatment are indications to offer urate-lowering therapy, but they do not by themselves establish the lower target. A target below 300 micromol/L (option E) should be considered in people with tophi or chronic gouty arthritis, or when frequent flares continue despite serum urate already being below 360 micromol/L. This patient has none of those features and her current urate is 510 micromol/L. Targets of 480 or 600 micromol/L remain above the monosodium urate saturation threshold and are inadequate, while below 200 micromol/L is not a recommended routine NICE target.

Reference: National Institute for Health and Care Excellence. Gout: diagnosis and management (NG219), sections 1.5.1 and 1.5.6–1.5.7. 2022. https://www.nice.org.uk/guidance/ng219/chapter/Recommendations