Gout — SCE Rheumatology MCQ

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ModerateCrystal ArthropathyGoutSCE Rheumatology

A 50-year-old woman with recurrent crystal-proven gout is starting treat-to-target urate-lowering therapy. She has chronic kidney disease category G3a but no history of myocardial infarction, stroke or unstable angina. According to NICE NG219, which is the appropriate first-line urate-lowering therapy choice?

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Correct answer: C — Allopurinol or febuxostat, selected according to comorbidities and patient preferences

The correct answer is C. NICE NG219 recommends either allopurinol or febuxostat as first-line treatment when initiating treat-to-target urate-lowering therapy, taking account of comorbidities and patient preferences. Chronic kidney disease G3a does not, by itself, make either drug the sole first-line option, although dosing and titration must be individualised. Allopurinol is specifically recommended first line when major cardiovascular disease is present, such as previous myocardial infarction, stroke or unstable angina; these are explicitly absent here. Probenecid and benzbromarone are not NICE-recommended first-line choices. Neither allopurinol nor febuxostat is otherwise mandated as the sole initial agent. Treatment should begin at a low dose and be titrated using monthly serum urate measurements towards a target below 360 micromol/L.

Reference: National Institute for Health and Care Excellence. Gout: diagnosis and management (NG219), recommendations 1.5.5–1.5.10. 2022. https://www.nice.org.uk/guidance/ng219/chapter/Recommendations