Chronic tophaceous gout — SCE Rheumatology MCQ

Correct answer: B — Repeat serum urate during dose titration until the individual target is reached, after safety review, with clinical reassessment

The best answer is “Repeat serum urate during dose titration until the individual target is reached, after safety review, with clinical reassessment”. NICE recommends serial serum-urate measurement during titration and dose adjustment until the target is achieved, followed by ongoing review; symptoms alone do not establish crystal depletion. The remaining choices—“Repeat plain radiographs every month, with clinical reassessment, within a rheumatology pathway, after specialist assessment, within a rheumatology pathway”, “Measure ESR after every allopurinol dose, within a rheumatology pathway, after safety review, with clinical reassessment, after safety review”, “Use urinary urate alone to determine dose, after safety review, after specialist assessment, within a rheumatology pathway”, “Stop monitoring once the first flare resolves, after specialist assessment, with clinical reassessment, after safety review, with clinical reassessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG219 gout: https://www.nice.org.uk/guidance/ng219/chapter/Recommendations