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We thank Drs Singh and Edwards for their interest in our 2016 revised EULAR recommendations for the management of gout.1 Drs Singh and Edwards were concerned about the latter part of our sixth recommendation, in which we indicate that a serum uric acid (SUA) level <3 mg/dL (<180 µmol/L) is not recommended in the long term. They consider that this part of the recommendation was not evidence based and that it might present a barrier to care. Specifically, they fear that it could make general practitioners (GPs) less engaged and less likely to use urate-lowering therapy (ULT) in the long term.2
First, in the care of people with gout, do we suggest that it is necessary to maintain such low levels of SUA indefinitely? No; we do not. In the discussion following recommendation 6 in our paper, we qualified that ‘long term’ stands for ‘several years’. Recommendation 6 clearly specifies that there is a therapeutic window during which physicians can clear crystals faster by lowering the SUA levels well below, rather than …
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