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Gout — SCE Rheumatology MCQ

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HardCrystal ArthropathyGoutSCE Rheumatology

A 48-year-old man with gout has persistent hyperuricaemia despite maximum Allopurinol. His rheumatologist suggests adding a uricosuric agent. According to BSR guidelines which combination approach is supported?

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Correct answer: B — Combination of Allopurinol with a uricosuric (Benzbromarone or Probenecid) can be considered if monotherapy fails

The best answer is “Combination of Allopurinol with a uricosuric (Benzbromarone or Probenecid) can be considered if monotherapy fails”. Combination of Allopurinol with a uricosuric (Benzbromarone or Probenecid) can be considered if monotherapy fails is supported by the cited UK or directly applicable specialist authority and best matches the tested threshold, complication or monitoring principle. The remaining choices—“principally Febuxostat plus Allopurinol is permitted, within a rheumatology pathway, after safety review, after specialist assessment”, “Combination ULT is generally initial, after safety review, after specialist assessment, with clinical reassessment”, “Uricosurics are rarely used in the UK, after specialist assessment, with clinical reassessment, within a rheumatology pathway”, “rarely combine xanthine oxidase inhibitor with uricosuric, with clinical reassessment, within a rheumatology pathway”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG219 gout: https://www.nice.org.uk/guidance/ng219/chapter/Recommendations