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Gout — SCE Rheumatology MCQ

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ModerateCrystal ArthropathyGoutSCE Rheumatology

A 45-year-old man with gout and CKD stage 3 is started on Allopurinol 100 mg daily. After 3 months his serum urate has fallen from 520 to 420 micromol/L but remains above target. What is the most appropriate next step?

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Correct answer: E — Switch to Probenecid

A treat-to-target strategy is central to gout management. BSR 2017 and NICE 2022 guidelines recommend uptitrating Allopurinol in 100 mg increments (every 2-4 weeks) to achieve the serum urate target. Doses above 300 mg may be needed, and the maximum is 900 mg daily. CKD does not prevent uptitration — the starting dose is lower and increments are slower, but the target remains the same. Current evidence (Stamp LK et al 2017) supports cautious dose escalation above creatinine clearance-based limits in CKD.

Reference: BSR 2017 gout guidelines; Stamp LK et al 2017 Allopurinol dose escalation in CKD