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A 52-year-old businessman presents to the Emergency department complaining of worsening pain in his right

Test Analysis

big toe and knee.

He has recently been diagnosed by his GP with gout, and you can see from the computer that his urate at the
time was 0.55 mmol/L (0.18-0.42). Current medication is 300 mg of allopurinol per day.
On examination he has severe pain and swelling over his right first MTP joint, consistent with gout.
What is the most appropriate management?
(Please select 1 option)
Add colchicine to his regime
Add naproxen to his regime
Decrease allopurinol to 100 mg
Decrease allopurinol to 200 mg
Stop allopurinol for a few days

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A 52-year-old businessman presents to the Emergency department complaining of worsening pain in his right

Answer Statistics

big toe and knee.

He has recently been diagnosed by his GP with gout, and you can see from the computer that his urate at the
time was 0.55 mmol/L (0.18-0.42). Current medication is 300 mg of allopurinol per day.

Test Analysis

On examination he has severe pain and swelling over his right first MTP joint, consistent with gout.
What is the most appropriate management?
(Please select 1 option)
Add colchicine to his regime

Incorrect answer selected

Add naproxen to his regime

This is the correct answer

Decrease allopurinol to 100 mg

Decrease allopurinol to 200 mg
Stop allopurinol for a few days

Guidelines on the management of acute gout and advice on what to do with an acute attack of gout whilst on
allopurinol exist in the summary of product characteristics (SPC) for the drug. These state that an acute flare
whilst on allopurinol should not lead to cessation of the agent, but that it should be continued at the same dose,
and a suitable non-steroidal anti-inflammatory agent added.

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Colchicine is a reasonable alternative but is known to precipitate diarrhoea when an efficacious dose is
reached, so is not normally the first line recommendation.

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Further Reading:
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Electronic Medicines Compendium. Allopurinol.

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