Which medication is used to manage chronic tophaceous gout?

Which medication is used to manage chronic tophaceous gout?

• A. Indomethacin
• B. Allopurinol
• C. Meloxicam
• D. Cyclobenzaprine

Answer: (B)

Lowering uric acid production over the long term is the key for chronic tophaceous gout, because tophi form and persist when uric acid remains high. Allopurinol fits this need by inhibiting xanthine oxidase, the enzyme that produces uric acid. By reducing uric acid synthesis, it helps dissolve tophi and prevents new ones from forming, which is exactly what chronic tophaceous gout requires. It’s a long-term urate-lowering therapy, not a treatment for an acute flare—that role is served by anti-inflammatory meds. It’s also not a muscle relaxant, which is why another option would not address the underlying issue here. In practice, you start after the acute attack subsides and titrate to reach and maintain a target serum urate level (often below 6 mg/dL, sometimes lower in tophaceous disease), with monitoring of kidney function and uric acid levels.

Lowering uric acid production over the long term is the key for chronic tophaceous gout, because tophi form and persist when uric acid remains high. Allopurinol fits this need by inhibiting xanthine oxidase, the enzyme that produces uric acid. By reducing uric acid synthesis, it helps dissolve tophi and prevents new ones from forming, which is exactly what chronic tophaceous gout requires. It’s a long-term urate-lowering therapy, not a treatment for an acute flare—that role is served by anti-inflammatory meds. It’s also not a muscle relaxant, which is why another option would not address the underlying issue here. In practice, you start after the acute attack subsides and titrate to reach and maintain a target serum urate level (often below 6 mg/dL, sometimes lower in tophaceous disease), with monitoring of kidney function and uric acid levels.