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A costly therapeutic dilemma in tophaceous gout: is etanercept or rasburicase preferable?
  1. M K Reinders1,
  2. E N van Roon1,
  3. J R B J Brouwers1,
  4. T L Th A Jansen2
  1. 1Department of Clinical Pharmacy and Pharmacology, Medical Centre Leeuwarden, Henri Dunantweg 2, Leeuwarden, The Netherlands
  2. 2Department of Rheumatology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
  1. Correspondence to:
    MrM K Reinders

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Tausche et al described a case of severe tophaceous gouty arthritis, which was treated with etanercept.1 They showed that anti-tumour necrosis factor α (TNFα) treatment can reduce the incidence of gouty attacks, which corresponds with the observation that TNFα is activated in patients with gouty arthritis.2 Clearly, this is a costly symptomatic approach that is only in addition to the main treatment, which is lowering the serum uric acid (SUA) level in order to deplete urate depots and prevent gouty attacks and joint damage in the long term.

In the case presented, uricosuric treatment could only lower SUA levels from 0.58 mmol/l to 0.56 mmol/l despite high doses of 2–3 g probenecid a day. This is in contrast with our experience. In our population of 95% undersecretors (defined as uric acid excretion in urine <6.0 mmol/day during …

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