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Gout prophylaxis — SCE Rheumatology MCQ

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EasyCrystal ArthropathiesGout prophylaxisSCE Rheumatology

A 49-year-old man starts allopurinol for recurrent gout. He had a flare 3 weeks ago but is currently asymptomatic. Renal function is normal and he has no contraindication to colchicine. He asks how to reduce the risk of flares when urate starts falling. What is the most appropriate management?

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Correct answer: A — Prescribe low-dose colchicine prophylaxis during initiation

Prescribe low-dose colchicine prophylaxis during initiation is best because colchicine prophylaxis reduces mobilisation flares when starting urate-lowering therapy. B is less suitable because denosumab treats osteoporosis; C is less suitable because amoxicillin prevents bacterial infection, not gout flares; D is less suitable because methotrexate is not gout prophylaxis; E is less suitable because being pain-free today does not remove early flare risk. Clinical pearl: urate crystals can provoke flares while the total crystal burden is being dissolved.

Reference: NICE NG219; BNF