skip to main content

Gout urate lowering — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

EasyCrystal ArthropathiesGout urate loweringSCE Rheumatology

A 55-year-old man has had four gout flares in 12 months and has a small tophus on the helix. Serum urate between attacks is 610 micromol/L and eGFR is 76 mL/min/1.73 m². He is currently pain-free. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Start allopurinol with flare prophylaxis and titrate to target urate

Explanation lettering: E = shown as A · D = shown as C · C = shown as D · A = shown as E

Start allopurinol with flare prophylaxis and titrate to target urate is best because recurrent flares and tophi warrant urate-lowering therapy, usually allopurinol first-line with prophylaxis and dose titration. B is less suitable because repeated NSAIDs do not prevent crystal burden progression; C is less suitable because monthly steroids create harm and do not lower urate; D is less suitable because febuxostat may be second-line and should not be started at maximal dose; E is less suitable because antihypertensive optimisation may help but stopping treatment is unsafe. Clinical pearl: urate-lowering therapy is titrated to biochemical target, not fixed at the starting dose.

Reference: NICE NG219; BSR gout guideline; BNF