Скачать или смотреть Case Study Advances in the Treatment of Gout with New Uric Acid Lowering Agents

This case highlights the use of new uric acid–lowering agents in managing refractory gout. A 52-year-old man with a 10-year history of gout, CKD stage 2, and intolerance or poor response to allopurinol and febuxostat continued to experience frequent flares, severe joint pain, and tophi. Despite colchicine and NSAIDs for acute attacks, his serum uric acid (SUA) remained high at 9.2 mg/dL.

Lesinurad was added as adjunct therapy, offering a modest decrease in SUA but not enough to meet the treatment target of less than 6 mg/dL. Persistent hyperuricemia and worsening symptoms led to the initiation of pegloticase, a recombinant uricase that converts uric acid into easily excretable allantoin.

Within one month, SUA dropped to 2.5 mg/dL, flares subsided, and mobility improved significantly. By three months, the patient reported no new attacks, reduced pain, and partial resolution of tophi. Pegloticase was well tolerated with no infusion reactions.

This case demonstrates how newer therapies—particularly pegloticase—can provide rapid, effective control for patients with refractory gout, improving long-term outcomes and quality of life when conventional treatments fail.