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Continue ULT During Gout Flare — RACP Adult Medicine MCQ

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EasyRheumatologyContinue ULT During Gout FlareRACP Adult Medicine

A 55-year-old man presents with an acute flare of gout. He is already on allopurinol 400 mg daily for urate-lowering therapy. His serum urate is 0.32 mmol/L (at target). Should allopurinol be ceased during the acute flare?

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Correct answer: E — Switch to febuxostat during the flare

A common misconception is that allopurinol should be stopped during an acute gout flare. Current guidelines (ACR 2020, EULAR 2016, eTG) strongly recommend CONTINUING urate-lowering therapy at the same dose during an acute flare. Stopping and restarting ULT causes serum urate fluctuations that can paradoxically prolong or worsen the flare. The acute flare should be treated with appropriate anti-inflammatory therapy (NSAIDs, colchicine, or corticosteroids) while ULT continues unchanged.

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