A 55-year-old man with gout has a serum urate of 9.8 mg/dL and two flares in the past year. He is started on allopurinol. The target serum urate level per ACR 2020 gout management guidelines is:

• A Less than 6.0 mg/dL ✓
• B Less than 7.0 mg/dL
• C Less than 5.0 mg/dL for all patients
• D Less than 4.0 mg/dL

Explanation

The 2020 ACR guideline for gout management strongly recommends a serum urate target of <6.0 mg/dL for all patients requiring urate-lowering therapy, as this is below the saturation threshold for monosodium urate crystal formation (6.8 mg/dL). A lower target of <5.0 mg/dL may be considered for those with severe or refractory gout (tophi, frequent flares), but <6.0 mg/dL is the standard target. Allopurinol should be started at low dose (100 mg/day) and titrated upward.

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

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