TY - JOUR T1 - Renal dosing of allopurinol results in suboptimal gout care JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - e1 LP - e1 DO - 10.1136/annrheumdis-2016-210352 VL - 76 IS - 1 AU - Tuhina Neogi AU - Nicola Dalbeth AU - Lisa Stamp AU - Geraldo Castelar AU - John Fitzgerald AU - Angelo Gaffo AU - Ted R Mikuls AU - Jasvinder Singh AU - Janitzia Vázquez-Mellado AU - N Lawrence Edwards Y1 - 2017/01/01 UR - http://ard.bmj.com/content/76/1/e1.abstract N2 - We commend the authors of the ‘2016 updated EULAR evidence-based recommendations for the management of gout’ for advocating starting allopurinol at a lower dose in patients with normal renal function.1 Specifically, this recognises an approach to potentially decrease the risk of precipitating flares of gout early in the course of urate lowering, and also to possibly decrease the risk of severe cutaneous reactions (SCARs) compared with higher starting doses of allopurinol.2 However, we note that the authors do not provide a recommendation on starting dose for patients with renal impairment, the patient group most likely to benefit from starting at a much lower dose of allopurinol.2Furthermore, recommendation #9,i which advocates limiting the maximal dose of allopurinol based on creatinine clearance (CrCL), is concerning. It is well-documented that such practice results in suboptimal management of hyperuricaemia in the majority of … ER -