Continue ULT During Flare — SCE Rheumatology MCQ

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EasyCrystal ArthropathyContinue ULT During FlareSCE Rheumatology

A 60-year-old man with gout is taking allopurinol, which is being gradually titrated to a serum urate target. He develops a typical acute gout flare in the right first metatarsophalangeal joint. He has no rash, fever, mucosal lesions or other evidence of allopurinol hypersensitivity, and renal function is normal. In addition to treating the acute flare, what should be done with his allopurinol?

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Correct answer: A — Continue it at the current dose during the flare

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

The correct answer is C. Flares are expected during initiation or up-titration of urate-lowering therapy because falling serum urate mobilises pre-existing crystal deposits; UK allopurinol SmPCs state that if an acute attack develops in a patient already receiving allopurinol, treatment should continue at the same dose while the attack is treated with a suitable anti-inflammatory agent (NSAID, colchicine or short-course corticosteroid). Stopping and restarting from the initial dose (A) delays reaching the urate target and perpetuates flares. Switching to febuxostat (B) is not indicated for a flare alone; it is reserved for intolerance or inadequate response. Permanent cessation (D) forfeits long-term crystal depletion. Doubling the dose (E) does not treat inflammation and risks toxicity. Allopurinol should be stopped only if hypersensitivity or a severe cutaneous reaction develops, explicitly excluded here.

Reference: electronic Medicines Compendium (eMC), Allopurinol 300 mg Tablet — SmPC, section 4.4 (acute gouty attacks); corroborated by NICE NG219 Gout: diagnosis and management (2022). https://www.medicines.org.uk/emc/product/100236/smpc