Rheumatology Q66

A 53-year-old man is evaluated for a 5-year history of recurrent gout attacks involving the base of the great toes, mid feet, and ankles. Episodes are becoming more frequent and severe. History is also significant for hypertension and stage 3 chronic kidney disease. Medications are lisinopril and metoprolol. The patient is of Thai descent.

On physical examination, vital signs are normal. There are no tophi or swollen joints.

Laboratory studies show a serum urate level of 9.2 mg/dL (0.54 mmol/L).

Which of the following is the most appropriate next step in management?

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