Acute Gouty ahritis is seen early in treatment following –
**Core Concept**
Acute gouty arthritis is a painful inflammatory condition caused by monosodium urate crystal deposition in joints, typically due to hyperuricemia. Certain uric acid-lowering drugs can induce a transient increase in serum uric acid levels, leading to acute gout flares during early therapy.
**Why the Correct Answer is Right**
Probenecid inhibits renal excretion of uric acid, increasing serum uric acid levels initially, which can trigger acute gout flares. Allopurinol reduces uric acid production by inhibiting xanthine oxidase, but patients may experience a transient rise in uric acid as the body clears existing uric acid, leading to flare-ups. Rasburicase, a recombinant urate oxidase, rapidly converts uric acid to allantoin, and this sudden uric acid reduction can also precipitate acute gout attacks. Thus, all three agents carry a risk of early gout flare.
**Why Each Wrong Option is Incorrect**
Option A: Probenecid increases serum uric acid, so it can cause acute gout flares — thus, it is not incorrect.
Option B: Allopurinol can cause early gout flares due to uric acid accumulation — thus, it is not incorrect.
Option C: Rasburicase can induce acute gout flares due to rapid uric acid depletion — thus, it is not incorrect.
Since all three agents are associated with early gout flares, "All of the above" is the most accurate choice.
**Clinical Pearl / High-Yield Fact**
Always anticipate acute gout flares during the first few weeks of starting any uric acid-lowering therapy — this is a key warning for safe initiation of treatment.
✓ Correct Answer: D. All of the above