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Recurrent gout prevention — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Recurrent gout preventionUSMLE Step 3

A 69-year-old man with gout and hypertension has had 4 gout flares in the past year. He takes hydrochlorothiazide and uses naproxen for attacks. Uric acid is 9.6 mg/dL, creatinine is 1.1 mg/dL, and he has no tophi. He asks how to prevent flares. Which of the following would you recommend at the follow-up visit?

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Correct answer: C — Start urate-lowering therapy and use flare prophylaxis during initiation

Recurrent gout flares are an indication for urate-lowering therapy, usually with flare prophylaxis during initiation. Thiazides can worsen hyperuricemia and should be reconsidered.

Reference: American College of Rheumatology gout guideline