American Board of Internal Medicine (ABIM) Certification Practice Exam

What should gout patients continue if there is evidence of active disease?

1. Pain medication only

2. Flare prophylaxis and urate-lowering therapy

3. Dietary modifications

4. Intra-articular glucocorticoids

The correct answer is: Flare prophylaxis and urate-lowering therapy

For gout patients exhibiting evidence of active disease, continuing flare prophylaxis and urate-lowering therapy is essential. Gout is characterized by hyperuricemia leading to joint inflammation, and managing both the acute symptoms and the underlying cause is crucial for patient care. When a patient is experiencing an acute gout flare, pain medication alone may provide temporary relief, but it does not address the underlying hyperuricemia, which is responsible for recurrent flares. Dietary modifications can be beneficial in the long run for managing uric acid levels, but they are not sufficient on their own during an active episode. Intra-articular glucocorticoids can be used for symptomatic relief of an acute flare, but they do not prevent future attacks nor do they lower uric acid levels effectively. Hence, the combination of flare prophylaxis and urate-lowering therapy provides not only immediate management during an active episode but also a long-term strategy to prevent further flares by controlling uric acid levels in the body. This holistic approach ensures better outcomes and improvements in the patient's quality of life.