Objective To explore the effects of fecal microbiota transplantation on blood uric acid (UA) metabolism, adverse reactions, and gout control in patients with refractory gout.

Methods A total of 102 patients with refractory gout in the First Affiliated Hospital of Medical College of Shantou University from June 2020 to June 2023 were randomly divided into two groups, with 51 cases in each group. Control group received benzbromarone and febuxostat treatment, while the observation group received fecal microbiota transplantation. The gout control status and occurrence of adverse reactions were observed in both groups; intestinal flora, UA, levels of C-reactive protein (CRP), interleukin-18 (IL-18), interleukin-6 (IL-6), and scores of joint pain, swelling and limited mobility were compared between the two groups before and after treatment.

Results Five patients in each group were lost to follow-up. The total gout control rate in the observation group was 89.13%, which was significantly higher than 69.57% in the control group (P < 0.05). At 4 and 12 weeks after treatment, the levels of Escherichia coli, UA, CRP, IL-18 and IL-6 as well as the scores of joint swelling, pain and limited mobility in the observation group were significantly lower than those in the control group, while the levels of Bifidobacterium, Lactobacillus and Bifidobacterium to Escherichia coli (B/E) ratio were significantly higher than those in the control group (P < 0.01). The total incidence of adverse reactions was 10.87% in the observation group and 6.52% in the control group, with no significant between-group difference (P>0.05).

Conclusion Fecal microbiota transplantation has a definite therapeutic effect for patients with refractory gout, which can significantly reduce UA level and control clinical symptoms, and its mechanism may be related to the correction of intestinal flora imbalance.