This study is for people with a type of arthritis called **gout**. Gout happens when there is too much uric acid in your blood, which can cause painful joint swelling. This study will test a medicine called **pegloticase** to see if taking it every 4 weeks (Q4W) is as good as taking it every 2 weeks (Q2W). Both groups will also take another medicine called **MTX (methotrexate)**, which may help the treatment work better. The study will last 48 weeks. For the first 24 weeks, neither you nor the doctor will know which treatment schedule you are on. After that, everyone will take pegloticase every 4 weeks for 24 more weeks.

• The study is 48 weeks long, with visits every few weeks.
• Participants must be at least 18 years old with uncontrolled gout.
• Participants should not have certain health issues like severe infections or recent heart problems.

If you join, you may help researchers find better ways to treat gout. Before joining, talk to your doctor about whether this study is a good fit for you.