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Knee osteoarthritis — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareKnee osteoarthritisUSMLE Step 3

A patient taking allopurinol 300 mg daily for tophaceous gout develops an acute podagra flare. Serum urate had been at target, and there is no drug toxicity. Which medication plan is appropriate?

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

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Correct answer: D — Continue allopurinol and treat the flare with an anti-inflammatory

The best answer is “Continue allopurinol and treat the flare with an anti-inflammatory”. Stopping established urate-lowering therapy causes urate fluctuation and does not treat inflammation. Allopurinol is continued at the established dose while colchicine, an NSAID or glucocorticoid is selected according to kidney function, interactions and contraindications.

Reference: American College of Rheumatology Guideline for the Management of Gout: https://rheumatology.org/gout-guideline