Treating Uric Acid Is Not Working is my review of two gout studies about treatment failure gout. So, it explains reasons why treating gout is not working. Then it offers options for you when you find your uric acid lowering treatment is not working as you expected.

Treating Uric Acid Is Not Working Audience

I wrote Treating Uric Acid Is Not Working for gout patients who are failing at Step 6 of their gout recovery plan. So, you should be familiar with GoutPal Plan for Gout Patients before you read this. Because a common reason why treating gout is not working is a lack of planning. Also, failure to agree on reasonable uric acid targets with your doctor.

Treating Uric Acid Is Not Working

During step 6 of your GoutPal Patient Treatment Plan, you should see your uric acid gradually falling towards your target level. Certainly, it should be falling below 6mg/dL. Because you do not start gout recovery until your uric acid is below 6mg/dL.

So, what do you do when treating uric acid is not working?

Firstly, your doctor should increase your uric acid medication dose. Then retest your blood for uric acid, kidney function, and liver function. But, if that doesn’t work, you need to change your plans. Before we look at that, I will describe two reports that investigate reasons why uric acid treatment can fail[1-2].

Uric Acid Treatment Failure Reasons

Edwards begins with some reasons why allopurinol is not working for some gout patients. Next, he explains why probenecid is not working for others. Then he introduces the term “Treatment Failure Gout” (TFG). But he needs to clarify its definition. Because some reasons for failure are not directly linked to the drug that is treating uric acid.

Also known as unresponsive, intransigent, or recalcitrant gout, TFG is very common:

between 100,000 and 300,000 of the nearly 5 million cases of gout in the US would not be adequately managed with current therapies.

So, new ways of treating uric acid are useful. But what about reasons for uric acid treatment failure?

Edwards distinguishes between avoidable and unavoidable reasons. But Ali & Lally give a useful list:

  1. Doctor fails to diagnose and treat gout.
  2. Uric acid medication doses too low.
  3. Patient cannot tolerate uric acid drugs.
  4. Can’t reach safe uric acid target.
  5. Patient fails to take prescribed medication.

So, we can see items 3 and 4 as unavoidable reasons why treating uric acid is not working. But the other three need to be addressed by changing attitudes and better dialog between gout patient and doctor. Because they are avoidable reasons for gout.

Treating Uric Acid Is Not Working
Disappointed with Uric Acid Treatment Failure?

Get Uric Acid Treatment Working Again

Where treatment failure gout is unavoidable, Edwards looks to pegloticase. Because pegloticase was being trialed at the time of his report. Subsequently, it launched as Krystexxa.

Later, Ali & Lally continued to explore the usefulness of Krystexxa. But, they also considered rasburicase (Fasturtec or Elitek) and surgery. Importantly, rasburicase is licensed for cancer patients who risk high uric acid from their cancer treatment. Also, surgery for tophaceous gout is very much a last resort:

It is universally recommended that before surgery is considered for the treatment of gout, optimal urate-lowering medical therapy should be employed to reduce the size of tophi.

Treating Uric Acid Is Not Working Conclusions

To summarize, the two important facts from both these reports are:

  1. There are five reasons why treating uric acid is not working. But three of those are avoidable.
  2. Where allopurinol and probenecid cannot be used, newer uric acid lowering drugs should provide gout recovery.

Get Your Uric Acid Treatment Working

Finally, you can see that most reasons for failing to get uric acid safe can be avoided. Especially if you have a good treatment plan. So, your first step is to consult your doctor about improving your uric acid lowering plan. But, if you don’t know what to ask for, you can get personal gout help from GoutPal.

Also, you might need to change your uric acid medication. Because new treatments give better choices when allopurinol isn’t working. But, there is an increasing tendency for doctors to consider combination treatments. So, it is often worth considering allopurinol combined with probenecid. Or, a different combination to suit your needs.

Combinations for lowering uric acid are beyond the scope of this article. Also, they rely on a good interpretation of your medical history. So, again, if you need help, ask about personal gout treatment plans.

Find the reasons uric acid drug fails
Get the right combo to stay on the rails

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Treating Uric Acid Is Not Working References

  1. Edwards, N. Lawrence. “Treatment-failure gout: A moving target.” Arthritis & Rheumatology 58.9 (2008): 2587-2590. Pegloticase for Treatment Failure Gout PDF.
  2. Ali, Saman, and Edward V. Lally. “Treatment failure gout.” Medicine and Health Rhode Island 92.11 (2009): 369. New Drugs for Treatment Failure Gout PDF.

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TL;DR - Treating Uric Acid Is Not Working

This page applies to Gout Patients who cannot achieve uric acid targets at Step 6 of GoutPal Plan for Gout Patients.

You can get personal gout help at anytime.
Find the reasons uric acid drug fails
Get the right combo to stay on the rails