If you’ve ever had an attack of gout, you know this type of arthritis can be both sudden and intensely painful. Many people with gout can avoid flares by taking medication and adopting a healthy lifestyle, but in about 2% of cases, it becomes an ongoing condition called chronic refractory gout. “Refractory” means stubborn or difficult, and those with this type of gout will understand why. Gout is caused when there’s too much uric acid in the blood. Our bodies produce uric acid naturally as a result of digesting certain foods. But with gout, uric acid builds up and causes problems. For patients with chronic refractory gout, uric acid levels remain high and joints stay swollen, red, and painful even when you are taking the most commonly prescribed gout medications. You may also develop bumps made of uric acid deposits under the skin, called “tophi,” which can cause deformities and may be disabling. If the pain and inflammation from your gout doesn’t go away and is affecting your quality of life, you may have chronic refractory gout, which can call for a different kind of treatment than less severe forms of the condition. Medications for Chronic Refractory Gout If your gout is not improving or is worsening, even if you are taking a gout medication like allopurinol (Zyloprim, Aloprim), it may be a sign that you have chronic refractory gout. In that case, there are other medications your doctor can prescribe to help address the cause of your refractory gout and reduce your symptoms. These medications include: Febuxostat (Uloric): a pill that lowers uric acid levels in the blood Probenecid (Benemid): a pill that helps the kidneys eliminate uric acid Lesinurad (Zurampic): a pill taken with allopurinol to help the kidneys eliminate uric acid Pegloticase (Krystexxa): an injection that lowers the amount of uric acid in the body when other medications have not worked These medications can be very effective but carry a risk of kidney, heart or other serious complications, so talk to your doctor about the pros and cons of these treatments. Your provider can also prescribe pain-relieving medications such as colchicine (Colcrys, Mitigare), nonsteroidal anti-inflammatory drugs (NSAIDS) or steroids to reduce your chronic refractory gout symptoms. Diet and Lifestyle Recommendations for Chronic Refractory Gout You can help manage your chronic refractory gout by following some simple diet and lifestyle recommendations. Avoid meat and shellfish Avoid alcohol, especially beer Drink cherry juice, which has been shown to help lower uric acid levels Keep your weight at a healthy level Exercise regularly Stay hydrated, unless you have certain kidney or heart conditions. Talk to your doctor about how much liquid you should drink. Gout, even chronic refractory gout, can often be successfully treated. Many people with gout stop their medications when the pain and inflammation subside, but it’s important to stick with it. If you stop and start uric acid reducers, you increase your risk of your chronic refractory gout recurring. Follow your doctor’s advice about your medication and diet, and you may well find that your chronic refractory gout no longer affects your everyday life.