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Gout — SCE Rheumatology MCQ

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EasyCrystal ArthropathyGoutSCE Rheumatology

A 45-year-old man attends follow-up after his first confirmed gout flare, which has now settled. He has normal renal function, is not taking a diuretic, and has no tophi or chronic gouty arthritis. According to NICE NG219, which approach to urate-lowering therapy (ULT) is appropriate?

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Correct answer: C — Discuss ULT now using a treat-to-target strategy

NICE recommends discussing the option of ULT, using a treat-to-target strategy, after a first or subsequent gout flare in people who do not already meet criteria for ULT to be offered. Therefore, ULT should be discussed with this patient now. ULT should be offered to people with multiple or troublesome flares, CKD stages 3–5, diuretic therapy, tophi or chronic gouty arthritis. Tophi and recurrent flares are therefore not prerequisites for discussion, and NICE specifies neither a requirement for three flares nor a serum urate threshold of 600 micromol/L. If ULT is chosen, it is generally started 2–4 weeks after a flare has settled; this timing recommendation is distinct from deciding whether to discuss treatment.

Reference: National Institute for Health and Care Excellence. NG219: Gout—diagnosis and management, recommendations 1.5.1–1.5.4. 2022. https://www.nice.org.uk/guidance/ng219/chapter/Recommendations