Question

A 40-year-old man presents with a swollen, tender, erythematous great toe. Serum urate is elevated. Lifestyle modification has been attempted and he has had three gout attacks in the last year. What is the most appropriate timing for commencing urate-lowering therapy such as allopurinol?

Accepted Answer

Commence allopurinol after the acute flare has settled, with low starting dose and gradual titration

Answer

Start allopurinol during the acute flare at high dose

Answer

Wait until he has tophaceous gout before starting allopurinol

Answer

Allopurinol is contraindicated after more than one attack

Answer

Use colchicine indefinitely instead of urate-lowering therapy

Practice question

A 40-year-old man presents with a swollen, tender, erythematous great toe. Serum urate is elevated. Lifestyle modification has been attempted and he has had three gout attacks in the last year. What is the most appropriate timing for commencing urate-lowering therapy such as allopurinol?