A 70-year-old man with chronic gout is started on allopurinol. Two weeks later he develops an acute gout flare. Which statement about prophylaxis against allopurinol-induced flares is correct?
- A Low-dose colchicine or an NSAID is given for 3 to 6 months when initiating allopurinol to prevent mobilization flares ✓
- B Allopurinol should be stopped immediately during the flare
- C Allopurinol should be doubled in dose to overcome the flare
- D Probenecid should be added to counteract the flare
Correct answer: A. Low-dose colchicine or an NSAID is given for 3 to 6 months when initiating allopurinol to prevent mobilization flares
Explanation
Initiating allopurinol lowers serum urate rapidly, causing mobilisation of urate from tissue deposits, which can trigger acute flares. Guidelines recommend prophylaxis with low-dose colchicine (or NSAIDs) for at least 3 to 6 months when starting urate-lowering therapy. Allopurinol should NOT be stopped during a flare. Doubling the dose worsens the problem. Probenecid is a uricosuric, not a flare treatment.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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