Question

A 66-year-old woman with newly diagnosed gout has 3 attacks this year, tophi on exam, urate 9.0 mg/dL, eGFR 62. Best long-term management plan?

Accepted Answer

Start allopurinol low-dose and titrate to serum urate <6 mg/dL with anti-inflammatory prophylaxis

Answer

Avoid urate-lowering therapy; treat attacks only

Answer

Start febuxostat 80 mg immediately without titration and no prophylaxis

Answer

Probenecid first-line regardless of tophi

Answer

Initiate pegloticase immediately

Practice question

A 66-year-old woman with newly diagnosed gout has 3 attacks this year, tophi on exam, urate 9.0 mg/dL, eGFR 62. Best long-term management plan?