Are there certain patients in whom you would avoid initiation of ULT during an acute gout flare?

Yes, I usually avoid it during first-time visits for gout flares. This is because the amount of information required during that visit would include:

1. The acute gout flare management, and
2. Information about gout in general.

Commonly, this is in addition to other intercurrent medical problems. Addin...

Yes. In a word “all”. I treat the flare, get the patient pain-free, which is to say a total reversal of inflammation, and then have the patient return for initiation of ULT under cover of ongoing prophylaxis, be it colchicine or NSAID or even prednisone.

ULT therapy will not influence treatment of a gout flare usually the flare lasts a few days so it is sort of a mute question as ULT requires years.