skip to main content

Gout Kidney Stones — SCE Rheumatology MCQ

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

HardCrystal ArthropathyGout Kidney StonesSCE Rheumatology

A patient with severe tophaceous gout and previous myocardial infarction cannot tolerate allopurinol despite careful re-challenge. Urate remains markedly above target. How should febuxostat be considered under updated MHRA advice?

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

Reveal the answer and explanation

Correct answer: E — Consider febuxostat cautiously after shared cardiovascular-risk discussion

Explanation lettering: B = shown as A · D = shown as B · A = shown as D

E is correct. Updated MHRA advice calls for caution—particularly during initiation and with high crystal burden—while retaining allopurinol as first line in major cardiovascular disease. It is not an absolute ban when allopurinol is unsuitable and treatment is still required. A is too absolute. B overstates reassurance. C is not routine strategy. D invents a risk-neutralising role for aspirin.

Reference: MHRA: updated febuxostat advice in major cardiovascular disease: https://www.gov.uk/drug-safety-update/febuxostat-updated-advice-for-the-treatment-of-patients-with-a-history-of-major-cardiovascular-disease