Question

A 55-year-old man with gout and CKD stage 3b (eGFR 38 mL/min/1.73 m²) has two flares this year and tophi. Best initiation strategy for urate-lowering therapy?

Accepted Answer

Start allopurinol ≤100 mg daily (lower in CKD) with treat-to-target urate <6 mg/dL and flare prophylaxis

Answer

Start allopurinol 300 mg daily and titrate rapidly

Answer

Start febuxostat 80 mg daily immediately

Answer

Start probenecid 500 mg BID

Answer

No ULT; manage flares only

Practice question

A 55-year-old man with gout and CKD stage 3b (eGFR 38 mL/min/1.73 m²) has two flares this year and tophi. Best initiation strategy for urate-lowering therapy?