When initiating urate-lowering therapy for gout, which precaution is recommended to prevent a flare?

• A. Start urate-lowering therapy without prophylaxis
• B. Use prophylactic antibiotics
• C. Administer anti-inflammatory before
• D. Avoid NSAIDs

Answer: (C)

Starting urate-lowering therapy can mobilize urate crystals from tissues and trigger an acute gout flare. To prevent this, begin anti-inflammatory prophylaxis at the same time as the urate-lowering therapy and continue for several months (using a low-dose colchicine or a short course of an NSAID), adjusting for kidney function and tolerability. Antibiotics have no role in preventing gout flares, and while NSAIDs may be contraindicated in some patients, the protective anti-inflammatory approach is the standard. This prophylaxis helps keep flares from interrupting urate lowering, allowing the therapy to reach its target safely.