Table 1

Common features of 'treatment-refractory' gout that complicate management

Polyarticular gout, uncontrolled flare activity, and/or chronic synovitis

Destructive tophi

Advanced age

Co-morbidities (for example, chronic kidney disease, cardiovascular disease, obesity, metabolic syndrome or diabetes, alcohol abuse)

Polypharmacy and drug interactions (for example, statins, macrolide antibiotics, oral anticoagulants)

Contra-indications or refractoriness to NSAIDs, colchicines, and/or glucocorticosteroids

Allopurinol intolerance or hypersensitivity and inability to employ uricosurics

Failure to adequately lower serum urate on appropriate doses of urate-lowering drugs


NSAID, nonsteroidal anti-inflammatory drug.

Terkeltaub Arthritis Research & Therapy 2009 11:236   doi:10.1186/ar2738