refractory Gout
Everything You Need to Know About Refractory Gout
Gout is a common form of inflammatory arthritis caused by an accumulation of uric acid crystals in the joints, causing pain, swelling, and stiffness. It typically affects the big toe, but it can also appear in the ankles, heels, knees, wrists, fingers, and elbows. While gout can be managed fairly well through lifestyle changes and medications, some cases of gout don’t respond to treatment and are considered refractory gout.
Refractory gout, known as chronic tophaceous gout, is a much more difficult condition to treat. It’s defined as lasting more than six months, or as experiencing recurrent flares every few months despite continued treatment. There could be a few reasons why gout is resistant to treatment, such as an inadequate dosage of medication, an underlying condition like kidney disease, or difficulty maintaining a healthy lifestyle.
What Causes Refractory Gout?
Though the causes of refractory gout aren't completely understood, there are certain factors that can make someone more susceptible to the condition. These include having a family history of gout, being of an older age, being male, taking diuretics or having an existing kidney condition, and having an overall unhealthy lifestyle, such as leading a sedentary lifestyle and obesity. Certain medications and diet choices may also increase the chances of developing refractory gout.
Symptoms of Refractory Gout
As with regular gout, refractory gout typically causes pain, swelling, redness, and tenderness in the affected joint. Symptoms can appear suddenly, and flares generally last about 10 days before resolving. Over time, symptoms may become more frequent and severe, leading to long-term joint damage, the formation of tophi (gouty deposits), joint deformities, and other complications.
Diagnosis of Refractory Gout
If your gout doesn't tend to respond to traditional treatments over time, your doctor may suspect that you have refractory gout. To diagnose this condition, they'll likely do a thorough physical exam and review your medical history. They may also order some tests to measure your uric acid levels and evaluate your joint health. This could include a blood test, X-ray, CT scan, or ultrasound.
Treatment of Refractory Gout
Since refractory gout is more challenging to treat, your doctor may recommend more aggressive treatment options. These may include:
- Higher dosages of traditional treatments, such as allopurinol (Zyloprim) or colchicine, to reduce the amount of uric acid in the body and decrease inflammation
- Pegloticase (Krystexxa), an enzyme injection that helps break down abnormally high levels of uric acid
- Corticosteroid injections directly into the joint
- Joint replacement surgery for severely damaged joints
Adopting lifestyle changes such as quitting smoking, following a healthy diet, and exercising regularly can also help reduce the severity of refractory gout symptoms. It’s important to work with your doctor to come up with an effective treatment plan if you have refractory gout.
