American Board of Internal Medicine (ABIM) Certification Practice Exam

In the absence of active gout, how long should colchicine be continued after reaching target serum urate?

1. 3 months

2. 6 months

3. 12 months

4. Until symptoms resolve

The correct answer is: 6 months

In managing hyperuricemia and gout, colchicine is often used as a prophylactic treatment to prevent acute flares, particularly when starting urate-lowering therapy. Once the target serum urate level has been achieved and maintained, it is essential to determine the appropriate duration for continuing colchicine. Current guidelines suggest that colchicine should be continued for at least 6 months after achieving the target serum urate level. This recommendation is based on evidence showing that continuing prophylactic colchicine during this period significantly reduces the risk of gout flares, which are more likely to occur during the initial months after initiating therapy. The rationale for a 6-month duration includes the fact that while urate levels may be normalized, flares can still occur as the body adjusts. The 6-month period helps ensure that patients are adequately protected from these flares while their urate levels stabilize. Continuing colchicine for longer than 6 months may not be necessary for all patients, especially in the absence of any active gout symptoms, as the risk of flares tends to decrease after this period once stable urate levels have been maintained. Hence, continuing colchicine specifically for up to 6 months is supported as a standard practice in clinical settings.