A 48-year-old man presents with acute monoarthritis of the first MTP joint (podagra). Serum uric acid is 9.8 mg/dL. Joint aspiration demonstrates negatively birefringent needle-shaped crystals. He is started on urate-lowering therapy. Per current ACR gout guidelines, what is the serum uric acid TARGET for patients with tophi?

• A Less than 8 mg/dL
• B Less than 7 mg/dL
• C Less than 6 mg/dL
• D Less than 5 mg/dL ✓

Explanation

Current ACR 2020 gout guidelines recommend a serum urate target of <6 mg/dL for most patients, but <5 mg/dL for patients with tophi to accelerate tophus dissolution by maintaining a steeper concentration gradient for urate mobilisation. Uricase cannot be inhibited, so MSU crystals dissolve more rapidly when serum urate is consistently below 5 mg/dL. Allopurinol or febuxostat are first-line urate-lowering agents.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.