Treatment Options for Severe Gout

By

Paige Greenfield

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When treating gout, your doctor has three goals: Reduce pain during an attack, prevent attacks from occurring again, and ward off complications due to gout, such as kidney stones. There are several different treatment options available for achieving these goals -- often used in combination. They include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin) and naproxen (Naprosyn) to reduce inflammation during painful gout attacks.

  • Corticosteroids, such as prednisone, which also control inflammation. They may be prescribed if you're unable to take NSAIDs because of ulcers, kidney disease, sensitivity or allergy to aspirin and similar medications, or potential interactions with other drugs you take, such as blood thinners.
  • Colchicine is a well-established anti-gout medication that is prescribed to treat acute gout flares and to prevent flareups. It works by blocking white blood cells so as to interrupt the pain and tissue damage pathways usually activated in gout.
  • Medications that block your body's production of uric acid. These include allopurinol (Lopurin, Zyloprim) and febuxostat (Uloric).

A New Option for Severe Gout

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While uric acid–lowering medications are successful in most people with gout, they fail to work in about 3 percent of patients. If you're one of them and your uric acid levels remain too high, you could be at risk for developing chronic gout. You may experience frequent and severe flares, pain, and disability and may be at risk for heart disease and kidney problems. That's why it's so important to get your uric acid levels under control.

Fortunately, there's another option available called pegloticase (Krystexxa). The FDA approved Krystexxa in 2010 for people with gout who do not respond to other treatments. This may be due to issues such as allergic reactions to those medications or interactions with other medications you take.

Is Krystexxa a Good Choice for You?

Krystexxa is given intravenously. It's an enzyme that lowers uric acid levels. It works by turning uric acid into a substance your body can expel in the urine more easily than uric acid. Other prescription drugs work differently.

Krystexxa may not help everyone, but it remains a valuable new treatment option. In a recent study, researchers gave Krystexxa to gout patients who either couldn't take the uric acid–lowering medication allopurinol or didn't achieve normal uric acid levels after taking it for three months. They found that after six months, Krystexxa resulted in lower uric acid levels in 35% of patients who received the drug monthly and 42% of patients who received it biweekly.

About one out of every four patients receiving an infusion of Krystexxa experiences a serious allergic reaction. You may receive a corticosteroid and an antihistamine before treatment to reduce your risk of a reaction.

Be Proactive!

There are many treatments available for gout. Every person is different, and you and your doctor will work together to design a treatment plan that works best for you.

Always take your medication exactly as prescribed. Let your doctor know if you notice any changes in your symptoms and if you think you're experiencing an attack. Gout attacks are most successfully controlled when you take medication at the first sign of pain or inflammation. 

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Feb 16, 2016

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Medical References

  1. Sundy JS, et al. Efficacy and Tolerability of Peglioticase for the Treatment of Chronic Gout in Patients Refractory to Conventional Treatment.JAMA. 2011;306(7):711-20.
  2. FDA Approves New Drug for Gout. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm225810.htm
  3. About KRYSTEXXA (peglioticase). KRYSTEXXA (peglioticase). http://www.krystexxa.com/about-krystexxa/
  4. Questions and Answers About Gout. National Institutes of Health. National Institute of Arthritis and Musculoskeletal and Skin Disease. http://www.niams.nih.gov/Health_Info/Gout/default.asp
  5. Handout on Health: Rheumatoid Arthritis. National Institutes of Health. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp    
  6. Gout. American College of Rheumat