Pick the right anti-inflammatory by comorbidity and renal function, and order the right gout labs and monitoring.
Clinical inputs
Comorbidities / context
Options
Low-dose colchicine has replaced high-dose regimens (equal efficacy, far less toxicity). Continue ULT through a flare; never stop it. A mobilisation flare during ULT titration is expected and is a sign of success.
Baseline gout panel
Serum urate — diagnostic baseline; if checked during a flare it may be normal/low, so recheck 2–4 weeks after the flare settles.
Full blood count — baseline before allopurinol/colchicine.
Liver function tests — baseline before allopurinol/febuxostat.
HbA1c / fasting glucose — CKM cluster.
Lipid panel — CKM cluster / CV risk.
Consider HLA-B*5801 — before allopurinol in higher-risk patients (see decision aid).
Specialist/selected: 24-h urinary uric acid (over- vs under-excretor, uricosuric candidacy); joint aspirate for crystals if diagnosis unclear or to exclude septic arthritis.
Monitoring schedule
Phase
Test & interval
Titration
Serum urate every 2–4 weeks until <0.36 (<0.30 if tophi)
Dose changes
Renal panel, FBC, LFTs at baseline & with each escalation
At target
Serum urate every 3–6 months, then 6–12 monthly
First 8 weeks
Review for SCAR (rash/fever/mucosa) on allopurinol