Gout is the most common type of inflammatory arthritis in the world and is caused by the buildup of uric acid crystals in your joints. These crystals form when there’s too much uric acid in your blood.

In the United States, gout affects 5% of the population. Of those with gout, fewer than 2% have chronic refractory gout. Refractory gout is a rare condition where gout symptoms are ongoing and resistant to treatment.

With refractory gout, you’re unable to maintain a target serum urate level of less than 6 mg/dl. You might also have more or larger tophi, which are hard swellings around the joint caused by the buildup of uric acid crystals.

This type of gout can eventually damage your joints and affect your mobility and quality of life.

The good news is that there are effective treatments for gout. Read on to learn more about refractory gout and how it can be treated.

Refractory gout develops after many years of uric acid buildup in your blood and tissues. It can result from:

  • gout that is not well controlled
  • medications losing their effectiveness
  • building up a tolerance to first-line treatments

In a review of studies published in 2019, the authors suggest that refractory gout is simply gout that’s not treated correctly, or develops as a result of poor adherence to a treatment regimen.

Some research indicates that up to 90% of people with gout don’t receive proper treatment, if any. Studies published in 2020 and 2021 indicate the need for more continuing education for rheumatologists so that they know how to more effectively treat gout.

Some symptoms of refractory gout include:

  • gout flare-ups that persist or get worse despite lifestyle changes and medication
  • larger or more numerous tophi
  • joint damage
  • decreased mobility or quality of life
  • serum urate level higher than 6 mg/dl for women and 7 mg/dl for men

Gout that’s resistant to treatment can get worse over time. It could also spread from one joint to several joints in the body, and it could damage your joints.

You’re also more likely to develop more, or larger, tophi.

Gout can also be acutely painful. This makes it difficult to walk with or move the affected joint or limb.

You may also have diagnosed or undiagnosed kidney problems. A 2019 study found those surveyed who had refractory gout also had lower renal (kidney) function.

Many people who have gout find their symptoms can be managed with standard short-term and long-term medication and lifestyle modification like dietary changes and exercise.

If those interventions don’t work for you, your healthcare professional may suggest trying another medication like pegloticase (Krystexxa).

Pegloticase is given intravenously and works in the body to change uric acid into a less harmful compound called allantoin. Pegloticase is only used after other methods have failed to manage symptoms.

As with other medications, your body may become tolerant over time and the medication may lose its effectiveness. Your healthcare professional may also recommend combining pegloticase with other medications.

You should see a doctor right away if:

  • you have sudden, severe pain in a joint
  • the pain is getting worse
  • you feel sick and can’t eat
  • you have a fever, which could indicate an infection in the joint that needs to be treated as soon as possible.

More serious ailment

Gout can cause severe pain when you have a flare-up. If you have pain that gets worse rather than goes away, or a fever and chills, seek medical treatment right away. A fever could indicate an infection in the joint that needs to be treated promptly to avoid further damage.

Refractory gout is diagnosed when your gout flare-ups continue or worsen despite treatment, and you have a serum urate level higher than 6 mg/dl for women and 7 mg/dl for men.

Gout can’t be cured, but it can be managed — even if you have refractory gout.

Adhering to your treatment plan is key to keeping your gout in remission and improving your mobility and quality of life. So are making some changes to your lifestyle.

The Centers for Disease Control and Prevention (CDC) recommend:

Refractory gout is diagnosed when your gout flare-ups continue or worsen even though you’ve made changes and taken the medication prescribed to you. It’s characterized by continued high levels of uric acid in your blood.

Your healthcare team can help you manage refractory gout by prescribing other medications like pegloticase, with or without other medications.

Adhering to your treatment plan, eating right, and exercising regularly with low impact aerobic activity can reduce or eliminate gout flare-ups and preserve a high quality of life.

If you do have a flare-up, it’s important to call your doctor right away if you have fever, chills, or pain that gets worse rather than goes away.