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Introduction Pegloticase, a potent uricolytic biologic enzyme, has been shown to be an effective therapeutic option in patients with uncontrolled gout. However, there are limited data on clinical response after a gap in therapy and retreatment with pegloticase. Case Series This report describes four patients with chronic gout who were successfully managed with pegloticase and were retreated following a gap in therapy. Patient charts from a practice-based rheumatology clinic were retrospectively analyzed; four male patients, aged 70–75 years, with chronic gout and a more than 4-week gap in pegloticase therapy were reviewed. Before pegloticase treatment, patients had received allopurinol or febuxostat, but they continued exhibiting symptoms, including visible tophi and serum uric acid (SUA) levels of 5.2–10.2 mg/dL (309–607 μmol/L), despite oral urate-lowering therapy. The first pegloticase treatment (8-mg infusion every 2 weeks) lasted 22–124 weeks. Pegloticase resolved tophi and improved SUA to below 1.5 mg/dL (less than 89 μmol/L); however, patients discontinued pegloticase because of symptom resolution, poor adherence, or personal reasons. Following treatment gaps (12–156 weeks), symptoms and SUA levels increased and patients were retreated with pegloticase (4–147 weeks). In three of four patients, reinitiating pegloticase lowered SUA levels to below 1.0 mg/dL (less than 59 μmol/L) and resolved symptoms. One patient experienced an infusion reaction and discontinued; no infusion reactions, gout flares, or adverse events occurred among the other three patients. Conclusion Retreatment with pegloticase after a gap in therapy appears to be an effective and tolerated option in prior responders. Funding Horizon Pharma.

Due to the increasing prevalence of gout, particularly in old age, the disease is becoming of increasing importance in Germany. Gout is one of the most common forms of recurrent inflammatory arthritis and is induced by the deposition of monosodium urate crystals in synovial fluid and other tissues. The principal goals of therapy in chronic gout are the symptomatic treatment of the acute joint inflammation and the causal treatment of the underlying metabolic cause, the hyperuricemia. Only a consistent and permanent reduction of the serum uric acid level ultimately results in an efficient avoidance of further gout attacks and therefore the prevention of structural damage. Due to an often inadequate treatment of gout, the target of healing the disease is often not achieved. A correct and timely diagnosis and adequate assessment of comorbidities associated with gout are, however, of substantial importance for patient and physician to achieve remission of the disease. In order to create a solid basis for a timely and effective treatment of affected patients, in 2016 the German Society of Rheumatology (DGRh) initiated the development of S2e guidelines on gouty arthritis for specialists. This article summarizes these S2e guidelines on the management of gouty arthritis in the specialist sector.

Gout is the most common inflammatory arthritis in adults. Given the increasing prevalence of gout and associated comorbidities, there is a growing need for better therapeutic options. While current treatment options satisfactorily control the disease in some patients, many patients, especially those with associated comorbidities, have contraindications to current treatments and need more treatment options. New drugs are needed to further improve our treatment, especially in patients with associated comorbidities. The duration of therapy for acute and chronic gout as well as combination of therapies, recommended by the American College of Rheumatology (ACR) guidelines, need to be further studied. The past decade has been an exciting time for gout research with significant advances in our understanding of disease pathogenesis and its treatment. The new ACR guidelines have improved gout visibility and will improve gout awareness and treatment in the future. With growing treatment options, gout is becoming a disease that can be cured.

Intravenous pegloticase (KRYSTEXXA®), a recombinant polyethylene glycol-conjugated form of uricase (a uric acid-specific enzyme lacking in humans), is a novel approach to treating chronic gout refractory to conventional therapy. Pegloticase 8 mg every 2 weeks provides sustained reductions in plasma uric acid levels to less than the therapeutic target of 6 mg/dL (360 μmol/L) in a substantial proportion of patients with chronic refractory gout. The risk of infusion-related reactions can be minimized by following the recommended precautions, which include monitoring of serum uric acid levels.

The rising prevalence of gout has led the pharmaceutical industry to rediscover what it had considered a forgotten disease. In April 2009, the Food and Drug Administration (FDA) approved febuxostat (Takeda Pharmaceuticals; Deerfield, IL), the first new urate-lowering gout drug in more than 40 years. In August 2009, the FDA approved colchicine for the treatment of acute gout. Several other pharmaceutical companies are also conducting clinical trials to test new drugs for acute and chronic gout. This article reviews new drugs and drugs in development in the management of acute and chronic gout.

Gout is a disorder of purine metabolism, usually associated with recurrent bouts of arthritis in the joints of the lower limbs, affecting men 40 to 50 years of age, which leads to the development of subcutaneous tophi in patients with long-lasting disease. Cases of patients with chronic gouty arthritis mimicking rheumatoid arthritis, and vice-versa, are rare. This report describes the case of a 56-year old male with symmetric, deforming, and polyarticular arthritis affecting, specially, the joints of the hands and wrists, with diffuse subcutaneous nodules throughout his body, atypical radiographic findings, and urolithiasis. Following clinical evaluation and additional tests, this patient received a diagnosis of chronic tophaceous gout mimicking mutilating rheumatoid arthritis.

The tophus is a characteristic and pathognomonic sign of chronic gout. Before effective drugs were available for the treatment of hyperuricaemia about 50 – 60% of patients with gout developed clinically and radiologically apparent urate crystal deposits. Clinical cutaneous manifestations of chronic gout are now rarely observed. However, the presence of degenerative tissues, as in idiopathic osteoarthritis of the fingers, may predispose to the deposition of urate crystals. We report on a patient with secondary – probably diuretic-induced – hyperuricaemia and gout tophi in Heberden's nodes.

Benemid zeigte eine auserordentlich gunstige Wirkung bei der Behandlung der chronischen Gicht. Es fuhrte zu einer Ausschwemmung von Uraten und zur Senkung des pathologisch erhohten Harnsaurespiegels im Serum. Durch gleichzeitige Verabreichung von Cortison konnte die sog. urikosurische Wirkung von Benemid wesentlich gesteigert werden. Besonders eindrucksvoll war die Verkleinerung der Tophi und die weitgehende Wiederherstellung der Beweglichkeit vorher fast immobiler Gelenke.