How do you approach the management of a patient with non-tophaceous gout who relapses upon withdrawal of acute gout prophylaxis despite adequate uric acid suppression on allopurinol?

The decision to initiate oral uric acid lowering therapy (ULT) is usually made when my patient has established a pattern of recurrent gout flares. Our discussion occurs during the flare, and the flare is treated. Depending on circumstances, the flare may be managed with colchicine, an NSAID, oral st...

I agree with the comprehensive answer of Dr. @Dr. First Last, with the following additional comments: Patients with "non-tophacous gout" may include individuals with chronic MSU deposition that is difficult to clinically detect (except perhaps by ultrasound, DECT or appropriately-stained histopathol...