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Gout Flare During ULT Initiation — RACP Adult Medicine MCQ

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EasyRheumatologyGout Flare During ULT InitiationRACP Adult Medicine

A 45-year-old man with recurrent gout (4 flares/year) is commenced on allopurinol 100 mg daily. Two weeks later he develops a gout flare. He is concerned the allopurinol caused it. What is the most appropriate advice?

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Correct answer: D — Continue allopurinol and treat the flare

Gout flares are common during ULT initiation due to mobilisation of urate from tissue deposits. Allopurinol should NOT be stopped during a flare — this prolongs the flare and delays reaching target urate. The flare should be treated with colchicine, NSAIDs, or prednisolone. Prophylactic colchicine (0.5 mg daily for 3–6 months) during ULT initiation reduces flare frequency by ~70%.

Reference: ARA – 2024 – Gout Guidelines; EULAR 2024 Gout; eTG Rheumatology 2024