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Table 1 Common features of 'treatment-refractory' gout that complicate management

From: Gout. Novel therapies for treatment of gout and hyperuricemia

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
  1. NSAID, nonsteroidal anti-inflammatory drug.