skip to main content

Tophaceous Gout — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

HardCrystal ArthropathyTophaceous GoutSCE Rheumatology

A patient with extensive tophaceous gout has had no flares for a year on allopurinol 500 mg daily. Serum urate is 338 micromol/L, renal function is stable and the visible tophi are only slowly shrinking. What is the best treat-to-target response?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Continue lifelong urate-lowering therapy and titrate, if tolerated, towards a serum urate below 300 micromol/L

Explanation lettering: E = shown as A · A = shown as E

C is correct. NICE recommends lifelong treat-to-target urate lowering and advises considering a target below 300 micromol/L in people with tophi, chronic gouty arthritis or ongoing frequent flares despite a level below 360. At 338 with substantial residual crystal burden, further safe titration or an alternative urate-lowering strategy should be discussed. A stops treatment before crystal dissolution and invites recurrence. B applies the general target without the lower-target indication. D confuses flare prophylaxis with urate removal. E uses glucocorticoid toxicity without reducing the urate pool. Dose decisions still require adherence review, tolerability, renal function and shared decision-making rather than an automatic numerical escalation.

Reference: NICE NG219: gout — diagnosis and management recommendations: https://www.nice.org.uk/guidance/ng219/chapter/Recommendations