Gouty Arthritis: A Novel Therapeutic Approach for Highly Resistant Patients

Introduction. Gouty arthritis normally is well controlled. Under extreme circumstances patients for various reasons may have to use Pegloticase (Krystexxa). About 30% of patients on Krystexxa develop immunogenicity or tolerance to the medication rendering it useless, and with use of immunosuppressants this tolerance can be blunted in almost 50% of patients, which leaves 15% with dialysis. To our knowledge, the first cases of severe gout and intolerance of Krystexxa, who were then placed on Allopurinol (Zyloprim) and Febuxostat (Uloric) and received a considerable benefit are presented in this clinical study. Methods. Three patients were diagnosed with Gouty arthritis and found intolerant of Krystexxa. Allopurinol 600mg daily with a taper of corticosteroids, history dependent, were introduced. Patients found to have uric acid levels that remained high were prescribed Uloric 40mg, titrated to 80mg as needed. Results. All patients’ uric acid levels were reduced from >12mg/dL to < 4 mg/dL and maintained at the lower levels. Conclusion. In cases of severe gout and intolerance of Krystexxa, Allopurinol and Uloric may provide considerable benefit.