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EULAR gout treatment guidelines by Richette et al.: uric acid and neurocognition
  1. Jasvinder A Singh1,2,3,
  2. N Lawrence Edwards4
  1. 1Birmingham VA Medical Center, Birmingham, Alabama, USA
  2. 2Department of Medicine, School of Medicine, University of Alabama, Birmingham, Alabama, USA
  3. 3Division of Epidemiology, School of Public Health, University of Alabama, Birmingham, Alabama, USA
  4. 4Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
  1. Correspondence to Dr Jasvinder A Singh, Division of Clinical Immunology and Rheumatology, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294, USA; Jasvinder.md{at}gmail.com

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We appreciate the efforts of the authors of the recent ‘2016 updated EULAR evidence-based recommendations for the management of gout’ and congratulate them on the publication.1 We would like to draw attention to recommendation #6: ‘For patients on urate-lowering therapy (ULT), serum urate (SUA) level should be monitored and maintained to <6 mg/dL (360 µmol/L). A lower SUA target (<5 mg/dL; 300 µmol/L) to facilitate faster dissolution of crystals is recommended for patients with severe gout (tophi, chronic arthropathy, frequent attacks) until total crystal dissolution and resolution of gout. SUA level <3 mg/dL is not recommended in the long term’. We agree with the first half of the recommendation that proposes the treat-to-target recommendations similar to that in the American College of Rheumatology 2012 gout treatment guidelines of reducing serum urate to <6.0 mg/dL in all patients with gout …

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