A 54－year－old man came to clinic. He has had multiple attacks of acute gout typically affecting the great toe. His last attack was a few days ago and was successfully treated with ibuprofen. His blood pressure is 128／75 mmHg， heart rate is 75／min， respiratory rate is 18／min， and temperature 36.4℃. There is a tophaceous deposit on the left forefoot. The physical examination is otherwise normal. Laboratory studies are also normal except for a serum uric acid level of 11.7 mg／dL.
