A 58-year-old man with recurrent gouty attacks (3 episodes in the past year) is started on allopurinol for long-term urate-lowering therapy. To prevent acute flares during the initial months of therapy, which prophylactic agent is recommended?

• A Indomethacin indefinitely
• B Aspirin 325 mg daily
• C Prednisone 40 mg daily
• D Colchicine 0.5-0.6 mg once or twice daily ✓

Explanation

Colchicine 0.5-0.6 mg once or twice daily is standard prophylaxis for 3-6 months when initiating urate-lowering therapy to prevent acute gout flares caused by mobilization of urate crystals. NSAIDs are used for acute attacks, not long-term prophylaxis. High-dose aspirin worsens hyperuricemia.

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

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