Which bridging therapy is recommended when starting urate-lowering therapy in chronic gout to reduce flare risk?

• A. Add on colchicine or NSAIDs for 6 months to avoid flares while waiting for therapy to become effective
• B. Prednisone 60 mg daily for 6 months
• C. No bridging therapy is ever needed
• D. Increase the urate-lowering dose immediately

Answer: (A)

When you start urate-lowering therapy in chronic gout, existing urate crystals can be mobilized and trigger inflammatory flares as the body adjusts to lower uric acid. To lessen this risk, guidelines recommend anti-inflammatory prophylaxis during the initial months of urate-lowering therapy. Colchicine or NSAIDs are commonly used for several months while the urate-lowering agent takes effect and uric acid targets are reached. This bridging approach lowers the frequency and severity of flares, helping patients tolerate and stick with the therapy until it becomes effective. A plan that relies on high-dose prednisone long-term isn't standard practice due to adverse effects. Skipping bridging therapy or escalating the urate-lowering dose immediately does not prevent the flare risk and can lead to more inflammation.