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Constitutional C4 Deficiency — SCE Rheumatology MCQ

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HardAutoimmune SerologyConstitutional C4 DeficiencySCE Rheumatology

A patient with crystal-proven gout is in a fourth flare within five months and has agreed to start allopurinol. The flare is responding to colchicine. When may urate-lowering therapy begin under NICE NG219?

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

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Correct answer: C — Begin during the current flare and discuss anti-inflammatory prophylaxis

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

C is correct. NICE usually starts ULT two to four weeks after a flare settles, but specifically allows initiation during a flare when flares are frequent. This patient has four attacks in five months, so delaying simply creates another untreated interval. Low-dose ULT is titrated monthly to target, and flare prophylaxis is discussed because mobilisation flares can occur. Serum urate can fall during acute inflammation and does not need to normalise before treatment. Existing allopurinol would also normally be continued during a flare.

Reference: NICE NG219: gout recommendations: https://www.nice.org.uk/guidance/ng219/chapter/Recommendations