A 60-year-old man has chronic gout with tophi on the elbows and recurrent flares despite diet changes. Serum urate is 10.1 mg/dL and eGFR is 62

Question

A 60-year-old man has chronic gout with tophi on the elbows and recurrent flares despite diet changes. Serum urate is 10.1 mg/dL and eGFR is 62 mL/min/1.73 m2. He is not having an acute flare today. Which of the following is the most appropriate next step in management?

Accepted Answer

Start urate-lowering therapy with treat-to-target monitoring

Answer

Avoid urate-lowering therapy because tophi are painless

Answer

Use aspirin as urate-lowering therapy

Answer

Perform tophus biopsy first

Answer

Prescribe antibiotics for tophi

Chronic gout tophi — USMLE Step 3 MCQ

A 60-year-old man has chronic gout with tophi on the elbows and recurrent flares despite diet changes. Serum urate is 10.1 mg/dL and eGFR is 62 mL/min/1.73 m2. He is not having an acute flare today. Which of the following is the most appropriate next step in management?