A 48-year-old man presents with recurrent acute monoarthritis of the first MTP joint. Synovial fluid analysis reveals negatively birefringent needle-shaped crystals under polarized light microscopy. His serum uric acid is 9.2 mg/dL and he has urate deposits visible on ultrasound. He has had 3 flares in the past year. Per current ACR 2020 gout guidelines, at what serum uric acid target should urate-lowering therapy be maintained?
- A Below 6 mg/dL ✓
- B Below 8 mg/dL
- C Below 7 mg/dL
- D Below 5 mg/dL in all patients with tophi
Correct answer: A. Below 6 mg/dL
Explanation
The 2020 ACR gout guidelines recommend a treat-to-target strategy aiming for serum urate below 6 mg/dL (360 μmol/L) in all patients requiring urate-lowering therapy. A lower target of <5 mg/dL may be considered in patients with tophi, frequent flares, or chronic gouty arthritis to more rapidly dissolve existing deposits. Allopurinol, started at 100 mg/day and titrated, is the preferred first-line urate-lowering agent. Flare prophylaxis with colchicine or NSAIDs is required for 3–6 months when starting ULT.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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