Gout

A 64-year-old with CKD stage 3 and a history of peptic ulcer presents within 12 hours of a mono-articular gout flare. Which first-line regimen is most appropriate?

• Indomethacin 50 mg TID

• Colchicine 1.2 mg now, then 0.6 mg in 1 hour (max 1.8 mg)

• Ibuprofen 800 mg Q6–8h + omeprazole

• Naproxen 500 mg BID

Which statement about urate-lowering therapy (ULT) is TRUE?

• Start ULT only after ≥3 flares/year and target sUA <7 mg/dL

• Start ULT for ≥2 flares/year, tophi, CKD ≥3, stones, or very high sUA; target <6 mg/dL (<5 mg/dL if tophi)

• Diet alone is first-line long-term control for most patients

• Stop prophylaxis when ULT is started

Which is the best initiation plan for allopurinol in a patient with normal renal function and recurrent flares?

• 300 mg daily, no prophylaxis; reassess in 2 weeks

• 100 mg daily, ↑ by 100 mg every 2–5 weeks until sUA goal, plus colchicine 0.5–1 mg/day for 3–6 months

• 50 mg every other day; no need to titrate

• Start after pegloticase is begun

Which comparison is correct?

• Febuxostat increases uric acid excretion (uricosuric) while allopurinol inhibits xanthine oxidase

• Both inhibit xanthine oxidase; febuxostat is more selective and may outperform fixed low-dose allopurinol, but treat-to-target allopurinol narrows differences

• Allopurinol only works in overproducers

• Febuxostat requires routine dose reduction in mild renal impairment

Which statement about pegloticase is TRUE?

• Continue allopurinol during pegloticase to enhance response

• Start without screening; sUA monitoring is unnecessary

• Discontinue if pre-infusion sUA >6 mg/dL on two consecutive checks, and screen for G6PD deficiency before starting

• Give SC every week at home