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Serum uric acid control for prevention of gout flare in patients with asymptomatic hyperuricaemia: a retrospective cohort study of health insurance claims and medical check-up data in Japan
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  • Published on:
    is it too early for patients with asymptomatic hyperuricemia recommended to control serum uric acid at 5-6 mg/dL?
    • Shiyuan Wei, Gynecologist Guangdong Second Provincial General Hospital
    • Other Contributors:
      • Licong Su, Nephrologist

    Dear Editor:
    In a recently published article in Ann Rheum Dis, Dr Ruriko Koto et al [1] performed a retrospective study to report the potential benefits of serum uric acid levels (sUA) control for preventing gout flare in subjects with asymptomatic hyperuricaemia. This topic is very meaningful because the current guidelines vary from country to country [2-4]. The study found that the occurrence of gout flare in asymptomatic hyperuricaemia and gout tended to be lower for patients who were prescribed ULT and achieved sUA ≤6.0 mg/dL than for controls. I appreciate the authors for designing such an excellent article, but I still want to make the following perspectives.
    Firstly, I don’t see any data about how many end-point events can be covered by the claims database? In other words, whether all patients with gout flare will fill out an insurance claim form? As we know, most of the drugs used to treat gout flare are over-the-counter drugs. For some patients with gout flare, they may choose to purchase drugs for treatment without being recorded in the claims database. It may result in missing some end-points for not combining the pharmacy data.
    Secondly, the authors only used two points of sUA to define the sUA control using annual medical check-ups data, which may cause misclassification for grouping because sUA is affected by many factors, such as a high-purine diet. Using multiple consecutive sUA testing data to define sUA control may obtain more accurate g...

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    Conflict of Interest:
    None declared.
  • Published on:
    Comment on Serum uric acid control for prevention of gout flare in patients with asymptomatic hyperuricaemia: a retrospective cohort study of health insurance claims and medical check-up data in Japan’
    • Hsiang-Hua Chang, Student School of Medicine, Chung Shan Medical University, Taichung, Taiwan
    • Other Contributors:
      • Cheng-Chung Wei, MD, PhD.

    Dear editor,
    We appreciate the article entitled ‘Serum uric acid control for prevention of gout flare in patients with asymptomatic hyperuricaemia: a retrospective cohort study of health insurance claims and medical check-up data in Japan’ written by R. Koto et al1., and read with great interest. The study reported that by using urate-lowering therapy (ULT), and maintaining the serum uric acid levels (sUA) of 6.0 mg/dl or lower, the risk of gout flare may be decreased. We congratulate the authors for the successful article, and would like to make some comments.
    Firstly, the authors introduced ULT to prevent gout flare in asymptomatic hyperuricaemia patients with sUA of 8.0 mg/dl or higher by adapting the Japanese guidelines. However, according to ACR20 guidelines2 and observational studies3, for patients with asymptomatic hyperuricemia, the development of annual incident rate of gouty arthritis was 4.9 percent in patients with sUA of 9.0 mg/dl or above. While patients with sUA of 7.0 to 8.9 mg/dl experienced such disease at an annual incident rate of 0.5 percent. Therefore, we suggest by enrolling asymptomatic hyperuricaemia patients with sUA of greater than 9.0mg/dl to the study, the potential treatment cost and risk would be more balanced.
    Secondly, we would like to emphasize the possible importance of renal protection that ULT may offer. The article showed significant results and strong evidence to support ULT in decreasing the risk of gout flare, and...

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    Conflict of Interest:
    None declared.