Refractory Chronic Gout (RCG)

Refractory chronic gout is the kind of gout that is resistant to conventional gout medications. In other words, it is the difficult-to-treat gout. In the US alone, it affects 3% of adults suffering from gout. Gout is classified as RCG when a patient has taken or is continually taking common drugs for gout that inhibit uric acid production or increase its removal by the kidney but is not responding well to them. More specifically the following symptoms are observed in refractory chronic gout patients:

Uric acid is consistently above 6mg/dL despite conventional medications.

Frequent gout flares occurring over relatively short period of time. This is often referred to as gouty arthritis. The constant pain and swelling can lead to joint damage as well as immobility. In some cases even causing mental and emotional stress as the pain from a gout attack can be very severe and debilitating.

Tophi or hardened uric acid crystals in the joints usually found in the joints of the fingers, feet and even earlobes. In some literature, refractory chronic gout is used interchangeably with tophaceous gout. RCG refers more to the “refractory” nature of the gout, meaning its resistance to conventional medication while tophaceous gout refers to condition resulting from RCG.

Resistance to conventional gout medications such as allopurinol, colchicine, febuxostat or uricosuric drugs like probenecid is another symptom from where the term “refractory” is derived. There also gout patients allergic to these medications which precludes taking them. In most RCG cases, conventional medication does not work even at optimal doses or produces severe side-effects such as diarrhea and vomiting. There are also cases that a gout patient is taking medications for other medical conditions that interact with conventional gout drugs.

A person is sure to have refractory chronic gout when there is more than one gout flare per year despite ongoing medication or problems like tophi, swollen and tender joints still persist after conventional medication. The tophi in RCG sufferers can get so bad that it interferes with daily activities. There are also cases when even a complete management including diet and lifestyle changes plus conventional medication did not eliminate flares or lower the uric acid level.

Refractory Chronic Gout Treatment

The only FDA approved drug in the US is an engineered urate oxidase enzyme called Pegloticase, marketed under the brand name Krystexxa. It is “engineered” from other sources because human beings like other higher primates lack the enzyme to breakdown uric acid which is the end-product of the breakdown of the protein purine. A urate oxidase enzyme like Pegloticase breaks down uric acid into allantoin, a substance soluble and water and easily removed in the urine.

Another thing that sets Pegloticase treatment is that it is given as an intravenous fluid. In clinical trials conducted, the most common adverse side-effects are infusion shocks and severe allergic reactions. Overall the drug has been well-received and proves to be effective for treatment of refractory chronic gout.