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Recurrent gout with chronic kidney disease — ABIM Board MCQ

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EasyRheumatology/Allergy/ImmunologyRecurrent gout with chronic kidney diseaseABIM Board

A 60-year-old man with CKD stage 3 has his third gout flare this year. Serum urate between flares is 9.4 mg/dL. He has no tophi. Which of the following is the most appropriate management?

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Correct answer: D — Start allopurinol at a low dose with anti-inflammatory flare prophylaxis

Frequent gout flares are an indication for urate-lowering therapy. Allopurinol is preferred first-line even in CKD when started low and titrated to urate target, with colchicine, NSAID, or steroid prophylaxis as appropriate.

Reference: 2020 American College of Rheumatology Gout Guideline