What is your approach to treating tophaceous gout in patients whose uric acid is below 5 prior to initiating uric acid lowering therapy?

The finding of tophi is associated with elevated total body uric acid. If this is a true serum uric acid, it is conceivable the patient is a high urine excretor to explain the low serum uric acid. Checking uric acid excretion could elucidate this.

Alternatively, low serum uric acid level could be a ...