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Tophaceous gout urate-lowering therapy — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareTophaceous gout urate-lowering therapyUSMLE Step 3

A 60-year-old man with gout has had three flares in 8 months. He has tophi on the ear. Serum urate is 9.8 mg/dL and eGFR is 58 mL/min/1.73 m2. He is currently asymptomatic. Which of the following is the most appropriate next step in management?

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Correct answer: B — Start allopurinol with anti-inflammatory flare prophylaxis

Recurrent flares and tophi are indications for urate-lowering therapy. Allopurinol is first-line, started at low dose with flare prophylaxis because urate shifts can trigger flares.

Reference: American College of Rheumatology Gout Guideline