A 50-year-old man with recurrent gouty attacks has completed treatment of an acute flare. His serum urate is 8.5 mg/dL on two measurements. Regarding initiation of urate-lowering therapy with allopurinol, the correct approach is:

• A Target serum urate between 7 and 8 mg/dL to avoid xanthine stone formation
• B Start full-dose allopurinol immediately with colchicine cover only if another flare occurs
• C Defer urate-lowering therapy until a tophus becomes clinically palpable
• D Start allopurinol at a low dose during the intercritical period and titrate to a serum urate target below 6 mg/dL ✓

Explanation

Urate-lowering therapy is indicated for recurrent flares with sustained hyperuricemia and should begin at low dose (100 mg/day, less in renal impairment) once the acute attack has settled, then be titrated against the target of serum urate below 6 mg/dL, below 5 mg/dL when tophi are present. Starting during an active flare or without gradual titration increases the risk of precipitating another attack.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.