American Board of Internal Medicine (ABIM) Certification Practice Exam

Pegloticase may be considered for which condition?

1. Acute gout flare

2. Refractory gout

3. Hypertensive crisis

4. Rheumatoid arthritis

The correct answer is: Refractory gout

Pegloticase is an enzyme used in the management of gout, specifically indicated for patients with refractory gout. This condition typically arises when patients have not responded adequately to conventional urate-lowering therapies, such as allopurinol or febuxostat, or when they are experiencing frequent and debilitating gout attacks despite treatment. Pegloticase works by converting uric acid into allantoin, a substance that can be easily excreted by the kidneys. This unique mechanism allows it to rapidly lower uric acid levels, making it particularly beneficial for those who have chronic, treatment-refractory hyperuricemia and recurrent gout attacks. In contrast, acute gout flare treatment usually involves non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids, rather than pegloticase. Conditions like hypertensive crisis and rheumatoid arthritis do not fall within the scope of pegloticase's clinical use, which is focused solely on treating specific cases of chronic gout that are resistant to other forms of treatment. Thus, pegloticase is specifically tailored for patients experiencing the challenges associated with refractory gout, making it the appropriate choice in this context.