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Gout Flare During ULT — SCE Rheumatology MCQ

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EasyCrystal ArthropathyGout Flare During ULTSCE Rheumatology

A 38-year-old man with gout has started Allopurinol 100 mg daily. Two weeks later he develops an acute gout flare despite having started Colchicine prophylaxis 0.5 mg BD. He is alarmed and wants to stop Allopurinol. What advice should be given?

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Correct answer: A — Continue Allopurinol as gout flares during ULT initiation are expected due to crystal mobilisation; treat the acute flare and continue prophylaxis

Gout flares during ULT initiation and dose titration are common and expected occurring in up to 30-40% of patients. They result from mobilisation of MSU crystals as serum urate falls (crystal shedding from dissolving deposits triggers inflammation). BSR 2017 and NICE 2022 guidelines strongly advise continuing ULT through an acute flare as stopping and restarting perpetuates the cycle. Patients should be counselled before starting ULT that flares may occur and that this indicates the treatment is working. Anti-inflammatory prophylaxis (Colchicine low-dose NSAID or low-dose corticosteroid) should be maintained for up to 6 months.

Reference: BSR 2017 gout guidelines; NICE NG219 (2022) gout guidelines