Allopurinol is prescribed for chronic tophaceous gout. The nurse explains that what condition can occur during the first few months of treatment?

Allopurinol is prescribed for chronic tophaceous gout. The nurse explains that what condition can occur during the first few months of treatment?

• A. Acute gouty arthritis
• B. Chronic kidney disease
• C. Migraine
• D. Iron deficiency anemia

Answer: (A)

Starting allopurinol in chronic tophaceous gout can trigger an acute gout flare in the first months because lowering uric acid mobilizes urate from tissue stores and tophi, destabilizing existing monosodium urate crystals in the joints and provoking an inflammatory attack. This transient surge in crystal shedding leads to sudden joint pain, swelling, and redness—the hallmark of an acute gouty arthritis episode. To reduce this risk, clinicians often add colchicine or a nonsteroidal anti-inflammatory drug during initiation and titrate the dose slowly while keeping the patient well hydrated. Not related are chronic kidney disease, migraine, or iron deficiency anemia, which are not expected effects of starting urate-lowering therapy.

Starting allopurinol in chronic tophaceous gout can trigger an acute gout flare in the first months because lowering uric acid mobilizes urate from tissue stores and tophi, destabilizing existing monosodium urate crystals in the joints and provoking an inflammatory attack. This transient surge in crystal shedding leads to sudden joint pain, swelling, and redness—the hallmark of an acute gouty arthritis episode. To reduce this risk, clinicians often add colchicine or a nonsteroidal anti-inflammatory drug during initiation and titrate the dose slowly while keeping the patient well hydrated. Not related are chronic kidney disease, migraine, or iron deficiency anemia, which are not expected effects of starting urate-lowering therapy.