How would you treat tophaceous gout after a course of pegloticase infusions if the patient has contraindications or intolerance to allopurinol, febuxostat, and probenecid?  

Difficult question. I think there are a number of issues to address. What is a "course of pegloticase?" What are the patient's contraindications to treatment? How did intolerance to prior oral uric acid-lowering therapies manifest Was pegltoicase started because of "unresponsiveness to oral UL...

A careful re-evaluation of the reported contraindications or intolerances to standard urate-lowering therapies (allopurinol, febuxostat, and probenecid) is essential before permanently excluding these options, as dose adjustment, desensitization, or re-challenge may occasionally be feasible. If tru...

It helps to see that other people may consider extending the Krystexxa if total contraindication to all of the standardtherapies.