refractory Gout
Refractory Gout
Refractory gout is a type of chronic gout which is characterized by recurrent gout flares, despite treatment with drugs to lower uric acid levels. It is the most severe form of gout, caused by an accumulation of uric acid crystals which further causes inflammation and joint pain, swelling and redness.
Gout flares may occur due to a trigger, such as certain foods, medications or injuries. They can also happen spontaneously with no clear trigger. Refractory gout occurs when gout flares do not respond to medications that are typically effective for controlling gout.
Causes of Refractory Gout
The primary cause of refractory gout is an accumulation of uric acid in the blood. This is caused by:
- High levels of uric acid in the blood (hyperuricemia) due to reduced excretion of uric acid from the kidneys.
- A buildup of uric acid crystals in the joints and soft tissues.
- An underlying medical condition such as kidney disease or high blood pressure (hypertension).
- Inadequate response to medications used to treat refractory gout.
- Age-related changes in metabolism that cause the body to produce more uric acid than it can excrete.
Symptoms of Refractory Gout
The most common symptom of refractory gout is a flare up of gout in one or more joints. A gout flare can cause a sudden onset of intense pain, swelling, redness and heat in the affected joint. It is often accompanied by stiffness of the joint, difficulty walking and limited range of motion. Other symptoms can include fever, fatigue, and malaise.
Treatment of Refractory Gout
Treatment of refractory gout focuses on reducing the amount of uric acid in the blood and the amount of uric acid crystals in the joints and soft tissues. Treatment may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen to reduce inflammation and pain.
- Corticosteroids such as prednisone to reduce inflammation and pain.
- Colchicine to reduce the formation of uric acid crystals.
- High-dose allopurinol to reduce uric acid production.
- Probenecid or lesinurad to improve excretion of uric acid from the body.
- Surgery to remove uric acid deposits.
In some cases, lifestyle changes may be recommended such as reducing alcohol consumption, avoiding certain foods or increasing physical activity.