Refractory Gout Is a Myth: Tips from an Expert

Refractory Gout: Myth

Professor Bardin said, “Refractory gout should be prevented and shouldn’t exist. Difficult-to-treat gout is not refractory gout. And severe gout is not always refractory.”

To illustrate his point, Professor Bardin shared data from his experiences treating gout in Vietnam. “When we introduced EULAR treatment recommendations at one center in Vietnam,” he said, “we looked at the first 100 severe gout patients with no previous ULT and no renal failure. To achieve target SU, we had to use a mean allopurinol dose of 520 mg +/-165 mg per day. It was striking to see how life changing allopurinol was for these patients. Flares disappeared, tophi decreased, and quality of life and level of function improved.”

In Sum

Over the past decade, major advances in gout care have truly rendered refractory gout a myth. Standard gout therapies like allopurinol and febuxostat—when properly prescribed and taken—are effective for most patients.

Patient and provider education is paramount to gout management success. In tougher cases, we have more options than we did previously, and hyperuricemia can be reduced via medications for comorbidities. Professor Bardin concluded, “I really believe that refractory gout is neglected gout and shouldn’t be seen anymore.”

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Samantha C. Shapiro, MD, is an academic rheumatologist and an affiliate faculty member of the Dell Medical School at the University of Texas at Austin. She is also a member of the ACR Insurance Subcommittee.

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