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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 …
Contributors JAS and NLE: first draft of the letter. JAS and NLE: revision of the letter and final approval for publication.
Competing interests JAS has received research grants from Takeda and Savient and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC and the American College of Rheumatology (ACR). JAS serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA, a 501 (c) (3) entity. JAS is a member of the executive of OMERACT, an organisation that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the ACR’s Annual Meeting Planning Committee; Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. NLE has received honorarium or consultant fees from Crealta, Horizon and Takeda.
Provenance and peer review Not commissioned; internally peer reviewed.