Question

A 35-year-old man presents with a painful, swollen first metatarsophalangeal joint. He has a history of similar attacks, elevated serum urate and tophaceous deposits. He has been on allopurinol 100 mg daily started during his last flare 2 months ago, which he has taken inconsistently. What is the most appropriate long-term strategy to prevent further flares?

Accepted Answer

Increase allopurinol dose gradually to achieve target serum urate and emphasise adherence, with prophylactic low-dose colchicine during titration.

Answer

Stop allopurinol permanently because it can precipitate flares.

Answer

Continue low-dose allopurinol only during acute flares.

Answer

Use NSAIDs continuously at full dose for prophylaxis without urate-lowering therapy.

Answer

Treat each flare with short courses of prednisone only, with no preventive therapy.

Practice question