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. The gene discussed is IL1B; the disease is osteoarthritis.