Internal Medicine II Practice Test

Managing an acute gout attack while planning long-term urate-lowering therapy requires separating immediate anti-inflammatory care from chronic urate control. For the acute flare, use anti-inflammatory treatment to rapidly relieve pain and inflammation—nonsteroidal anti-inflammatory drugs or colchicine are first choices, with steroids reserved if NSAIDs or colchicine are not suitable. This addresses the current inflammation and helps the patient regain function quickly. For long-term prevention, aim to lower serum urate with a xanthine oxidase inhibitor such as allopurinol or febuxostat. Start urate-lowering therapy after the acute attack has resolved, not during the flare, to avoid prolonging or worsening inflammation. When initiating urate-lowering therapy, it’s common to add flare prophylaxis with low-dose colchicine or NSAIDs for several months to prevent new attacks during the adjustment period. The goal is to reach and maintain a target serum urate—generally below 6 mg/dL, and even lower (below 5 mg/dL) if tophi are present—through regular monitoring and dose adjustment. Probenecid is an option in patients with good renal function and underexcretion, but it’s not universally used and still benefits from urate level monitoring. Overall, treatment combines effective control of the acute episode with careful, monitored reduction of uric acid to prevent future flares.