Translationally, selective MMP-1 inhibitors (e.g., AZD1236), currently in phase II trials for osteoarthritis, warrant evaluation in refractory gout patients with radiographically confirmed erosions, particularly when combined with IL-1β blockade to concurrently mitigate inflammasome activation and ECM degradation – a precision strategy that may halt structural progression in this clinically aggressive subtype. This evidence concerns the gene IL1B and gout.