A 50-year-old man with poorly controlled gout develops acute pain and swelling of the first MTP joint. X-ray shows joint space narrowing, periarticular erosions with overhanging edges, and soft tissue tophi. He is on allopurinol 300 mg. Target serum urate level for gouty arthropathy with tophi, per current guidelines, is:

• A < 5 mg/dL (< 300 μmol/L) ✓
• B < 6 mg/dL (< 360 μmol/L)
• C < 7 mg/dL (< 420 μmol/L)
• D < 4 mg/dL (< 240 μmol/L)

Explanation

Current ACR (2020) and EULAR guidelines recommend targeting serum urate <6 mg/dL for most gout patients and <5 mg/dL for patients with tophi, frequent flares, or destructive joint disease. This lower target accelerates tophus dissolution and reduces flare frequency by ensuring urate concentration is well below the saturation point of monosodium urate crystals (approximately 6.8 mg/dL). Allopurinol dose should be titrated upward to achieve target, not capped at 300 mg.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.