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Gout treatment target — SCE Rheumatology MCQ

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ModerateCrystal ArthropathiesGout treatment targetSCE Rheumatology

A 63-year-old man with tophaceous gout takes allopurinol 100 mg daily. He has no adverse effects and eGFR is 64 mL/min/1.73 m². Serum urate remains 470 micromol/L after 3 months and he has had another flare. He asks whether the dose should stay low because of age. What is the most appropriate management?

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

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Correct answer: B — Increase allopurinol gradually while monitoring

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

Increase allopurinol gradually while monitoring is best because allopurinol should be titrated upwards to achieve target serum urate if tolerated. A is less suitable because long-term prednisolone does not reduce urate burden; B is less suitable because aspirin is not used for urate lowering and low doses may raise urate; C is less suitable because unchanged low dose leaves crystals unresolved; D is less suitable because stopping allopurinol during early flares prevents urate control. Clinical pearl: early flares after starting urate-lowering therapy do not mean treatment failure.

Reference: NICE NG219; BNF