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Gout Prophylaxis Cessation — RACP Adult Medicine MCQ

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ModerateRheumatologyGout Prophylaxis CessationRACP Adult Medicine

A 65-year-old man with chronic gout has achieved a serum urate of 0.30 mmol/L on allopurinol 600 mg daily with colchicine prophylaxis for 8 months. He has had no flares for 6 months. His tophi are resolving. When can colchicine prophylaxis be ceased?

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Correct answer: E — After 6 months at target urate without flares

Flare prophylaxis (colchicine 500 mcg daily) should be continued for at least 6 months after achieving target serum urate, and longer if flares continue or significant tophi remain. The rationale is that dissolving urate crystal deposits triggers mobilisation flares. Once urate has been at target for ≥6 months without flares and tophi are significantly reduced, prophylaxis can be carefully ceased with monitoring. Some guidelines extend to 3–6 months after complete tophus resolution.

Reference: eTG – 2025 – Rheumatology; ACR – 2020 – Gout Management Guideline