A 52-year-old man with obesity and hypertension presents with acute monoarthritis of the first MTP joint. Serum urate is 9.8 mg/dL. During this acute episode, which of the following is the correct management regarding urate-lowering therapy (ULT)?
- A Start allopurinol immediately to hasten resolution
- B Do not start ULT during acute flare; start after flare resolves ✓
- C Start febuxostat at high dose to prevent recurrence
- D Avoid all NSAIDs due to cardiovascular risk
Correct answer: B. Do not start ULT during acute flare; start after flare resolves
Explanation
Traditional teaching recommends not initiating ULT during an acute gout flare, as abrupt changes in serum urate levels can prolong or precipitate attacks. However, recent ACR 2020 guidelines suggest ULT may be started during an acute flare if the patient is on adequate anti-inflammatory cover. The classic approach is still widely accepted in NEET PG context: control the acute attack first (colchicine, NSAIDs, or corticosteroids), then initiate ULT after resolution, under colchicine prophylaxis cover.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.