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Correspondence response
Response: Renal dosing of allopurinol results in suboptimal gout care by T Neogi et al
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  1. Pascal Richette1,2,
  2. Michael Doherty3,
  3. Eliseo Pascual4,
  4. Thomas Bardin5
  1. 1INSERM U1132 and University Paris-Diderot, Paris, France
  2. 2Department of Rheumatology, Hopital Lariboisiere, Paris, 75010, Île-de-France, France
  3. 3Academic Rheumatology, University of Nottingham, Nottingham, UK
  4. 4Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
  5. 5Department of Rheumatology, Hôpital Lariboisière, Paris, France
  1. Correspondence to Professor Pascal Richette, INSERM U1132 and University Paris-Diderot, Paris, France; pascal.richette{at}lrb.aphp.fr

https://doi.org/10.1136/annrheumdis-2016-210356

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    We sincerely appreciate the interest shown by Dr T Neogi⇓ and colleagues1 concerning our 2016 revised European League Against Rheumatism (EULAR) recommendations for the management of gout.2

    Dr T Neogi and colleagues raised concern with the ninth item, in which we recommend to adjust the maximum dosage of allopurinol according to the creatinine clearance (CrCl) in order to decrease the risk of severe cutaneous allergic reactions (SCARs).

    First, we would like to emphasise that these recommendations were written from a European perspective. In many countries in Europe, regulatory agencies require this adjustment, an important point we took into account for the elaboration of this recommendation. Furthermore, in addition to rheumatologists, the task force included general practitioners, who manage the vast majority of people with gout, patients with gout who are on urate-lowering treatment, and evidence-based medicine (EBM) experts. Therefore, the recommendations reflect perspectives from multiple stakeholders and follow the principles of EBM by examining all types of evidence (patient views, expert opinion and experience, research evidence) in the realisation that each has its strengths and weaknesses, and it is only when …

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    • Electronic pages
      Renal dosing of allopurinol results in suboptimal gout care
      Tuhina Neogi Nicola Dalbeth Lisa Stamp Geraldo Castelar John Fitzgerald Angelo Gaffo Ted R Mikuls Jasvinder Singh Janitzia Vázquez-Mellado N Lawrence Edwards
      Annals of the Rheumatic Diseases 2016; 76 e1-e1 Published Online First: 31 Aug 2016. doi: 10.1136/annrheumdis-2016-210352