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Febuxostat safety — SCE Rheumatology MCQ

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HardCrystal ArthropathiesFebuxostat safetySCE Rheumatology

A 69-year-old man with recurrent gout cannot tolerate allopurinol because of a severe rash. He has previous myocardial infarction and heart failure. eGFR is 58 mL/min/1.73 m² and serum urate is 590 micromol/L. He is pain-free today. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: D — Discuss febuxostat risk-benefit and specialist review

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

Discuss febuxostat risk-benefit and specialist review is best because febuxostat may be considered when allopurinol is not tolerated, but cardiovascular history requires careful risk-benefit discussion and often specialist input. A is less suitable because probenecid is less suitable with renal impairment and is not first-line here; B is less suitable because colchicine alone prevents flares but does not lower urate burden; C is less suitable because high-dose aspirin is not a urate-lowering strategy; E is less suitable because starting without discussion ignores safety cautions. Clinical pearl: urate-lowering choices must account for prior allopurinol reaction and cardiovascular risk.

Reference: NICE NG219; MHRA febuxostat safety advice; BNF