Gout

Overview

Gout is a form of inflammatory arthritis caused by uric acid crystals that form in and around joints when uric acid levels in the blood stay high. Most people control it with oral medicines that lower uric acid. Some have chronic gout that continues, with repeated flares or crystal lumps called tophi, despite those medicines.

Common Signs and Symptoms

• Sudden, intense joint pain, often in the big toe, but also in the ankle, knee, wrist or fingers
• Redness, warmth and swelling of the joint
• Firm lumps of crystals under the skin (tophi)
• Flares that keep coming back
• Joint damage over time

When to Contact a Provider

See a provider about a sudden hot, painful, swollen joint. A hot joint with fever needs urgent care to rule out infection.

How Treatment May Help

Flares are treated with anti-inflammatory medicines, colchicine or steroids, and uric acid is usually lowered long term with oral medicines such as allopurinol or febuxostat.

When these don't bring uric acid to goal or can't be tolerated, a rheumatologist may prescribe Krystexxa, an enzyme that breaks down uric acid. It may help lower uric acid levels and shrink tophi over time. It is often prescribed together with methotrexate to help it keep working.

Therapies That May Be Available at Infuse Care

• Krystexxa (pegloticase): IV infusion every two weeks, for adults with chronic gout that has not responded to conventional treatment

Safety and Monitoring

Krystexxa can cause serious allergic and infusion reactions, so you receive medicines beforehand and are monitored during and after each infusion. Your uric acid level is checked before each infusion, because a rising level can signal that the medicine is losing effect and that the risk of a reaction is higher.

You will be tested for G6PD deficiency before starting, because Krystexxa can cause serious blood problems in people with this condition. Gout flares are common in the first months of treatment, and oral uric acid-lowering medicines are stopped while you are on Krystexxa.

Your prescribing provider decides which treatment is right for you. Infuse Care administers prescribed therapies after a referral, a clinical review and any required insurance authorization, and we keep your provider's office updated on your care.