A 52-year-old male presents with excruciating acute pain, erythema, and swelling of the first metatarsophalangeal joint. Why should allopurinol NOT be initiated during this acute flare?
Answer and explanation
Correct answer: C. Rapid serum urate changes prolong or worsen the acute attack
- Step 1: Acute podagra is caused by inflammatory phagocytosis of monosodium urate crystals in the joint space.
- Step 2: Initiating urate-lowering therapy during an acute gout flare mobilizes crystal stores and alters serum urate concentrations, which prolongs and exacerbates joint inflammation; it should be started only after the acute flare resolves.
Answer
Rapid serum urate changes prolong or worsen the acute attack.
Why not the others: Allopurinol hypersensitivity is linked to the HLA-B*58:01 allele, not the acute phase of a joint flare. Allopurinol has good oral bioavailability. Allopurinol is the standard first-line maintenance agent for chronic hyperuricemic gout.
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