{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T22:48:33Z","timestamp":1785797313661,"version":"3.56.0"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T00:00:00Z","timestamp":1771027200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T00:00:00Z","timestamp":1771027200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Gout is an increasingly prevalent condition with high global burden of disease due to a myriad of factors, including population ageing, rising affluence, changes in dietary habits and higher rates of obesity and metabolic syndrome. While many cases of gout flares can be managed with standard anti\u2010inflammatory medications (colchicine, non\u2010steroidal anti\u2010inflammatory drugs and\/or corticosteroids), increasingly, there are patients who are refractory, intolerant or unsuitable (due to associated cardiometabolic conditions) for such treatments \u2013 whom we define as the \u201cdifficult\u2010to\u2010treat\u201d cases. In this article, we sought to provide a practical approach to treating such cases of complex and refractory gout flares, through a simple 4A acronym (consider\n                    <jats:styled-content>A<\/jats:styled-content>\n                    lternate diagnosis, use of\n                    <jats:styled-content>A<\/jats:styled-content>\n                    nakinra and other IL\u20101 receptor antagonists,\n                    <jats:styled-content>A<\/jats:styled-content>\n                    CTH injections and\n                    <jats:styled-content>A<\/jats:styled-content>\n                    djuvant measures).\n                  <\/jats:p>","DOI":"10.1111\/imj.70349","type":"journal-article","created":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T11:45:44Z","timestamp":1771069544000},"page":"490-493","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["How I treat complex and refractory gout flares"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1843-5948","authenticated-orcid":false,"given":"Isaac K. S.","family":"Ng","sequence":"first","affiliation":[{"name":"Division of Rheumatology and Allergy, Department of Medicine National University Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson G. W.","family":"Goh","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine National University Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1232-9308","authenticated-orcid":false,"given":"Li Feng","family":"Tan","sequence":"additional","affiliation":[{"name":"Healthy Ageing Programme Alexandra Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desmond B.","family":"Teo","sequence":"additional","affiliation":[{"name":"Integrated Medicine Programme Alexandra Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,14]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(24)00117-6"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.5114\/aoms\/175469"},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24180"},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-820605-8.00015-2"},{"key":"e_1_2_4_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1265"},{"key":"e_1_2_4_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.38917"},{"key":"e_1_2_4_8_1","volume-title":"Rheumatology Secrets","author":"West S","year":"2020"},{"key":"e_1_2_4_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-024-01137-1"},{"key":"e_1_2_4_10_1","first-page":"831","article-title":"Diagnosis, treatment, and prevention of gout","volume":"90","author":"Hainer BL","year":"2014","journal-title":"Am Fam Physician"},{"key":"e_1_2_4_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-215315"},{"key":"e_1_2_4_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keg297"},{"key":"e_1_2_4_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-200908"},{"key":"e_1_2_4_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-023-03098-4"},{"key":"e_1_2_4_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar4159"},{"key":"e_1_2_4_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/key402"},{"key":"e_1_2_4_17_1","doi-asserted-by":"publisher","DOI":"10.34067\/KID.0000000000000221"},{"key":"e_1_2_4_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2020.04.010"},{"key":"e_1_2_4_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40259-022-00537-7"},{"key":"e_1_2_4_20_1","first-page":"137","article-title":"Crystallising the role of adrenocorticotrophic hormone in the management of acute gout: a review","volume":"37","author":"Nisar M","year":"2019","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_4_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-022-05128-x"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70349","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/imj.70349","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70349","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T15:06:38Z","timestamp":1773241598000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.70349"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,14]]},"references-count":20,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/imj.70349"],"URL":"https:\/\/doi.org\/10.1111\/imj.70349","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,14]]},"assertion":[{"value":"2025-11-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}