This study is testing two ways to give a medicine called pegloticase to help people with gout, a painful condition caused by too much uric acid in the blood. Pegloticase helps lower uric acid levels. The study will compare giving the medicine under the skin (subcutaneous, SC) every two weeks to giving it through a vein (intravenous, IV) every two weeks. Both methods include another medicine called methotrexate (MTX). The goal is to see which method works better to keep uric acid levels normal over six months.

• Study Length: 6 months, with regular visits every two weeks.
• Participation Requirements: Adults with uncontrolled gout, who can follow the study rules and take the prescribed medicines.
• Exclusions: People with certain health issues like liver problems, uncontrolled diabetes, or known medicine intolerances may not join.