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Urate target failure — SCE Rheumatology MCQ

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ModerateCrystal arthropathiesUrate target failureSCE Rheumatology

A 58-year-old man takes allopurinol 100 mg daily after recurrent gout. Examination shows he has two flares in 6 months. Investigations show serum urate remains 470 micromol/L and adherence is good. What is the most appropriate management?

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Correct answer: A — Titrate urate-lowering therapy to target

Titrate urate-lowering therapy to target is the most appropriate management because it matches the crystal diagnosis, comorbidity and infection risk. The tempting alternatives either ignore renal or drug safety, fail to lower urate long term, or delay septic arthritis treatment. Crystal arthritis care separates acute anti-inflammatory treatment from long-term urate-lowering strategy.

Reference: NICE NG219; BSR gout guideline; EULAR CPPD recommendations; BNF