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Gout Metabolic Syndrome — SCE Rheumatology MCQ

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HardCrystal ArthropathyGout Metabolic SyndromeSCE Rheumatology

A patient with gout, chronic kidney disease and previous myocardial infarction requires urate-lowering therapy. Which initial strategy best aligns NICE with current MHRA cardiovascular advice?

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Correct answer: C — Use titrated allopurinol first; reserve cautious febuxostat for intolerance

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

E is correct. NICE supports treat-to-target urate lowering, while MHRA retains allopurinol as first-line therapy in major cardiovascular disease. Low-dose initiation and titration address flare and toxicity risk without therapeutic inertia. A delays indicated disease modification. B reverses the safety advice. C ignores reduced uricosuric utility and patient-specific contraindications. D treats inflammation but not crystal burden.

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