Stay informed for your
patients and practice.

See full ACR Guidelines

Visit the American College of Rheumatology website to download the Guidelines.

According to the Guidelines, ULT titration should occur over weeks to months, not years.

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Learn about:

  • LINDA
  • JAMES

Meet Linda, a patient you may see in your practice

Actor portrayal of gout patient, James

Patient Name:

Linda, 55

Occupation:

Accountant

Actor portrayal, not actual patient.
Patient history icon

Patient History

  • Diagnosed 4 years ago
  • Family has a history of gout
  • Flares: multiple flares in the last year
  • Tophi: 1 small, bothersome tophus on her hand
  • Comorbidities: hypertension

KRYSTEXXA is not indicated for the treatment of pain.

BMI, body mass index; BP, blood pressure; G6PD, glucose-6-phosphate dehydrogenase; QD, every day; sUA, serum uric acid.

Laboratory Workup

sUA level:

8.2 mg/dL

G6PD:

normal

BMI:

29

BP:

128/80

Treatment history icon Current Treatment

Allopurinol:

300 mg QD (for the past year)

Losartan:

50 mg QD

Flare Medication

Colchicine:

0.6 mg QD

Patient Background
  • Linda has been on treatment for some time, but she feels the disease just isn’t getting any better. Linda has missed work due to her disease, and even when present, the pain and distraction have made her much less efficient. While her tophus is small, it’s caused increased mental and emotional strain

KRYSTEXXA is not indicated for the treatment of pain. BMI, body mass index; BP, blood pressure; G6PD, glucose-6-phosphate dehydrogenase; QD, every day; sUA, serum uric acid.

Meet James, a patient you may see in your practice

Actor portrayal of gout patient, James

Patient Name:

James, 52

Occupation:

Middle school teacher

Actor portrayal, not actual patient.
Patient history icon

Patient History

  • Has been seeing a primary care physician for gout for the last 15 years—his disease has rapidly progressed
  • Flares: 6 in the last year
    •  3 mitigated with flare prophylaxis
    •  2 resulted in urgent care visits
    •  1 mitigated with a cortisone injection
  • Tophi: tophi on his hands, feet, specifically ankle and MTP joint, and elbows
  • Comorbidities: diabetes

KRYSTEXXA is not indicated for the treatment of pain.

A1C, glycated hemoglobin; BID, twice daily; BMI, body mass index;

G6PD, glucose-6-phosphate dehydrogenase; MTP, metatarsophalangeal; QD, every day; sUA, serum uric acid.

Laboratory Workup

sUA level:

9.3 mg/dL

G6PD:

normal

BMI:

31

A1C:

7.3%

Treatment history icon Current Treatment

Allopurinol:

300 mg QD (for the past year)

Metformin:

850 mg QD

Linagliptin:

5 mg QD

Flare Medication

Colchicine:

0.6 mg QD for prophylaxis

Naproxen:

500 mg BID

Patient Background
  • Uncontrolled gout has affected James’s ability to present in class and educate his students due to an increase in gout flares
  • Tophi growth has caused him to feel self-conscious when students talk about his “bumpy hands”
  • James has been absent from work every few months due to heightened flare pain in his feet and difficulty moving around. This has made him nervous about job security, resulting in financial worry

KRYSTEXXA is not indicated for the treatment of pain. A1C, glycated hemoglobin; BID, twice daily; BMI, body mass index; G6PD, glucose-6-phosphate dehydrogenase; MTP, metatarsophalangeal; QD, every day; sUA, serum uric acid.

Learn about Bet, a real patient on KRYSTEXXA

Before & After KRYSTEXXA With Methotrexate

Bet story Icon

REAL PATIENT

Patient name/age:

Occupation:

Stay-at-home parent

The ACR Guidelines STRONGLY RECOMMEND pegloticase for patients like Bet3

KRYSTEXXA can be coadministered with methotrexate4

Patient history icon

Patient History

  • A father and husband who loves spending time with his children
  • Has had gout for over 20 years
  • Stopped working construction due to pain and limited mobility
  • No known comorbidities
Lab Evaluation

Physical & Lab Evaluation

Before

  • sUA level: 10.4 mg/dL
  • BMI: 38.5
  • Tophi: Visible tophi
  • Swollen/tender joints: Chronic pain in multiple joints
  • Flares: >2/year

After

  • sUA level: <1 mg/dL
  • Tophi: Reduced
  • Functional Status: Can walk and perform daily activities
Treatment History

Treatment History

Before

  • Allopurinol: 7 years with increasing doses
  • Colchicine: 7 years while flaring
  • Febuxostat: 1 year

Image of visible tophi in hand before KRYSTEXXA treatmentBEFORE

Enlarge

After

  • Colchicine: 0.6 mg as needed
  • Methotrexate: 15 mg orally per week
  • KRYSTEXXA: 8 mg every 2 weeks

Image of no visible tophi in hand after KRYSTEXXA treatmentAFTER

Enlarge

Best results were seen at 6-12 months.4 Optimal treatment duration has not been established.4 Individual results may vary.

Best results were seen at 6-12 months.4 Optimal treatment duration has not been established.4 Individual results may vary.

“I wish I had started KRYSTEXXA (with methotrexate) sooner. Now, I go out and do things and not just want to stay at home. I’m definitely in a better place now.”

KRYSTEXXA is not indicated for the treatment of pain.

ACR, American College of Rheumatology; BMI, body mass index; sUA, serum uric acid.

Evaluate Your Gout Patients Using “STOP”3
sUA>6

Is their uric acid level
>6 mg/dL?

TOPHI

Do they have nonresolving tophi?

ORAL ULT FAILURE

Have they been taking the maximum medically appropriate dose of ULTs?

PAINFUL FLARES

Have they had 2 or more painful flares in the past year?

Click to rotate

Uncontrolled gout is not defined by having all of the criteria above. KRYSTEXXA is not indicated for the treatment of pain.

ULT, urate-lowering therapy.

Need more data?

The KRYSTEXXA team is available to share more about the systemic nature of uncontrolled gout.

Request Support

KRYSTEXXA with methotrexate

KRYSTEXXA works differently for your patients with uncontrolled gout.

See How It Works

IMPORTANT SAFETY INFORMATION

WARNING: ANAPHYLAXIS AND INFUSION REACTIONS, G6PD DEFICIENCY ASSOCIATED HEMOLYSIS AND METHEMOGLOBINEMIA

  • Anaphylaxis and infusion reactions have been reported to occur during and after administration of KRYSTEXXA.
  • Anaphylaxis may occur with any infusion, including a first infusion, and generally manifests within 2 hours of the infusion. Delayed hypersensitivity reactions have also been reported.
  • KRYSTEXXA should be administered in healthcare settings and by healthcare providers prepared to manage anaphylaxis and infusion reactions.
  • Premedicate with antihistamines and corticosteroids and closely monitor for anaphylaxis for an appropriate period after administration of KRYSTEXXA.
  • Monitor serum uric acid levels prior to each infusion and discontinue treatment if levels increase to above 6 mg/dL, particularly when 2 consecutive levels above 6 mg/dL are observed.
  • Screen patients at risk for glucose-6-phosphate dehydrogenase (G6PD) deficiency prior to starting KRYSTEXXA. Hemolysis and methemoglobinemia have been reported with KRYSTEXXA in patients with G6PD deficiency. KRYSTEXXA is contraindicated in patients with G6PD deficiency.

CONTRAINDICATIONS:

  • In patients with G6PD deficiency.
  • In patients with history of serious hypersensitivity reactions, including anaphylaxis, to KRYSTEXXA or any of its components.

WARNINGS AND PRECAUTIONS

Gout Flares: An increase in gout flares is frequently observed upon initiation of anti-hyperuricemic therapy, including KRYSTEXXA. Gout flare prophylaxis with a non-steroidal anti-inflammatory drug (NSAID) or colchicine is recommended starting at least 1 week before initiation of KRYSTEXXA therapy and lasting at least 6 months, unless medically contraindicated or not tolerated.

Congestive Heart Failure: KRYSTEXXA has not been formally studied in patients with congestive heart failure, but some patients in the pre-marketing placebo-controlled clinical trials experienced exacerbation. Exercise caution in patients who have congestive heart failure and monitor patients closely following infusion.

ADVERSE REACTIONS

The most commonly reported adverse reactions (≥5%) are:

KRYSTEXXA co-administration with methotrexate trial:

KRYSTEXXA with methotrexate: gout flares, arthralgia, COVID-19, nausea, and fatigue; KRYSTEXXA alone: gout flares, arthralgia, COVID-19, nausea, fatigue, infusion reaction, pain in extremity, hypertension, and vomiting.

KRYSTEXXA pre-marketing placebo-controlled trials:

gout flares, infusion reactions, nausea, contusion or ecchymosis, nasopharyngitis, constipation, chest pain, anaphylaxis, and vomiting.

INDICATION

KRYSTEXXA® (pegloticase) is indicated for the treatment of chronic gout in adult patients who have failed to normalize serum uric acid and whose signs and symptoms are inadequately controlled with xanthine oxidase inhibitors at the maximum medically appropriate dose or for whom these drugs are contraindicated.

Limitations of Use: KRYSTEXXA is not recommended for the treatment of asymptomatic hyperuricemia.

Please see Full Prescribing Information, including Boxed Warning.

IMPORTANT SAFETY INFORMATION

WARNING: ANAPHYLAXIS AND INFUSION REACTIONS, G6PD DEFICIENCY ASSOCIATED HEMOLYSIS AND METHEMOGLOBINEMIA

  • Anaphylaxis and infusion reactions have been reported to occur during and after administration of KRYSTEXXA.
  • Anaphylaxis may occur with any infusion, including a first infusion, and generally manifests within 2 hours of the infusion. Delayed hypersensitivity reactions have also been reported.
  • KRYSTEXXA should be administered in healthcare settings and by healthcare providers prepared to manage anaphylaxis and infusion reactions.
  • Premedicate with antihistamines and corticosteroids and closely monitor for anaphylaxis for an appropriate period after administration of KRYSTEXXA.
  • Monitor serum uric acid levels prior to each infusion and discontinue treatment if levels increase to above 6 mg/dL, particularly when 2 consecutive levels above 6 mg/dL are observed.
  • Screen patients at risk for glucose-6-phosphate dehydrogenase (G6PD) deficiency prior to starting KRYSTEXXA. Hemolysis and methemoglobinemia have been reported with KRYSTEXXA in patients with G6PD deficiency. KRYSTEXXA is contraindicated in patients with G6PD deficiency.

CONTRAINDICATIONS:

  • In patients with G6PD deficiency.
  • In patients with history of serious hypersensitivity reactions, including anaphylaxis, to KRYSTEXXA or any of its components.

WARNINGS AND PRECAUTIONS

Gout Flares: An increase in gout flares is frequently observed upon initiation of anti-hyperuricemic therapy, including KRYSTEXXA. Gout flare prophylaxis with a non-steroidal anti-inflammatory drug (NSAID) or colchicine is recommended starting at least 1 week before initiation of KRYSTEXXA therapy and lasting at least 6 months, unless medically contraindicated or not tolerated.

Congestive Heart Failure: KRYSTEXXA has not been formally studied in patients with congestive heart failure, but some patients in the pre-marketing placebo-controlled clinical trials experienced exacerbation. Exercise caution in patients who have congestive heart failure and monitor patients closely following infusion.

ADVERSE REACTIONS

The most commonly reported adverse reactions (≥5%) are:

KRYSTEXXA co-administration with methotrexate trial:

KRYSTEXXA with methotrexate: gout flares, arthralgia, COVID-19, nausea, and fatigue; KRYSTEXXA alone: gout flares, arthralgia, COVID-19, nausea, fatigue, infusion reaction, pain in extremity, hypertension, and vomiting.

KRYSTEXXA pre-marketing placebo-controlled trials:

gout flares, infusion reactions, nausea, contusion or ecchymosis, nasopharyngitis, constipation, chest pain, anaphylaxis, and vomiting.

INDICATION

KRYSTEXXA® (pegloticase) is indicated for the treatment of chronic gout in adult patients who have failed to normalize serum uric acid and whose signs and symptoms are inadequately controlled with xanthine oxidase inhibitors at the maximum medically appropriate dose or for whom these drugs are contraindicated.

Limitations of Use: KRYSTEXXA is not recommended for the treatment of asymptomatic hyperuricemia.

Please see Full Prescribing Information, including Boxed Warning.

  • Perez-Ruiz F. Rheumatology (Oxford). 2009;48(suppl 2):ii9-ii14.
  • Shoji A, et al. Arthritis Rheum. 2004;51:321-325.
  • FitzGerald JD, et al. Arthritis Care Res (Hoboken). 2020;72:744-760.
  • KRYSTEXXA (pegloticase) [prescribing information] Horizon.