A 58-year-old man with a history of hypertension and diuretic use presents with acute monoarthritis of the first MTP joint. Synovial fluid shows needle-shaped, negatively birefringent crystals. Serum urate is 9.8 mg/dL. He has had 4 attacks in the past year. After controlling the acute attack, the MOST appropriate long-term urate-lowering target is:

• A Serum urate < 8 mg/dL
• B Serum urate < 6 mg/dL ✓
• C Serum urate < 4 mg/dL only in tophaceous gout
• D Serum urate < 5 mg/dL

Explanation

ACR 2020 gout guidelines recommend a treat-to-target strategy with the serum urate goal of < 6 mg/dL for all patients on urate-lowering therapy (ULT). In patients with tophi or frequent attacks (as in this case with 4 attacks per year), a more stringent target of < 5 mg/dL may be preferred to accelerate crystal dissolution. Allopurinol is first-line ULT, starting at 100 mg/day and titrating. A target of < 8 mg/dL is inadequate as this remains above the saturation point (6.8 mg/dL) where crystals form.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.