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Allopurinol initiation in gout — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsAllopurinol initiation in goutGPhC CRA

A 62-year-old with frequent flares and tophaceous gout has started allopurinol 100 mg daily after discussing urate-lowering treatment. Serum urate is 430 micromol/L after four weeks and renal function is stable. Which long-term plan best matches NICE guidance?

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Correct answer: E — Titrate allopurinol to urate below 300 micromol/L and discuss flare prophylaxis

NICE recommends a treat-to-target approach: start urate-lowering treatment at a low dose and use monthly serum-urate measurements to guide dose increases until target is reached. The usual target is below 360 micromol/L, but below 300 micromol/L should be considered for tophi or ongoing frequent flares. Colchicine prophylaxis should be discussed while target is being reached. Treatment is normally long term and is not used only during attacks.

Reference: NICE NG219: Gout diagnosis and management: https://www.nice.org.uk/guidance/ng219/chapter/recommendations