Refractory Tophaceous Gout With Psoriatic Arthritis: A Case Report

Although gout is a common intermittent crystalline arthropathy, tophaceous gout is a rare condition. Flares of this disease are usually treated with anti-inflammatory drugs followed by control of serum uric acid levels. We present a refractory, severe, tophaceous gout overlapping with psoriatic arthritis, presenting with a hyper-inflamed phenotype resistant to conventional anti-inflammatory and hypouricemic agents. Control of the disease was only achieved after the introduction of IL-1-blocking therapy. This case highlights the need to control inflammation as the first step in gout treatment and underscores the increasing need for personalized therapies in more complex patients.