Management of Gout
Authors: Jasvinder A. Singh, Kenneth G. Saag
Journal: Annals of Internal Medicine (2017)

Letters6 June 2017Management of GoutJasvinder A. Singh, MBBS, MPH and Kenneth G. Saag, MD, MScJasvinder A. Singh, MBBS, MPHFrom University of Alabama at Birmingham, Birmingham, Alabama.Search for more papers by this author and Kenneth G. Saag, MD, MScFrom University of Alabama at Birmingham, Birmingham, Alabama.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0211 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read Qaseem and colleagues' guideline on management of gout (1) with interest. We agree with Neogi and Mikuls' accompanying editorial recommending that—similar to diabetes mellitus—treatment of gout must not rely solely on symptom relief, because preventing joint destruction and disability is important. However, we are concerned that the guideline takes a step back in the treatment of high serum urate levels, the underlying defect in gout. Qaseem and colleagues cite a lack of knowledge of cost and harms versus benefits of a treat-to-target strategy—one that is widely accepted in clinical practice—and offer an alternate, unproven, new ...References1. Qaseem A, Harris RP, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Management of acute and recurrent gout: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166:58-68. [PMID: 27802508]. doi:10.7326/M16-0570 LinkGoogle Scholar2. Becker MA, Schumacher HR, Wortmann RL, MacDonald PA, Eustace D, Palo WA, et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med. 2005;353:2450-61. [PMID: 16339094] CrossrefMedlineGoogle Scholar3. Sundy JS, Baraf HS, Yood RA, Edwards NL, Gutierrez-Urena SR, Treadwell EL, et al. Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials. JAMA. 2011;306:711-20. [PMID: 21846852] doi:10.1001/jama.2011.1169 CrossrefMedlineGoogle Scholar4. Ferraz MB, O'Brien B. A cost effectiveness analysis of urate lowering drugs in nontophaceous recurrent gouty arthritis. J Rheumatol. 1995;22:908-14. [PMID: 8587081] MedlineGoogle Scholar5. Snow V, Aronson MD, Hornbake ER, Mottur-Pilson C, Weiss KB; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Lipid control in the management of type 2 diabetes mellitus: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2004;140:644-9. [PMID: 15096336] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Alabama at Birmingham, Birmingham, Alabama.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0211. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoManagement of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Russell P. Harris , Mary Ann Forciea , and Management of Gout: A Systematic Review in Support of an American College of Physicians Clinical Practice Guideline Paul G. Shekelle , Sydne J. Newberry , John D. FitzGerald , Aneesa Motala , Claire E. O'Hanlon , Abdul Tariq , Adeyemi Okunogbe , Dan Han , and Roberta Shanman Management of Gout Paul G. Shekelle and Sydne J. Newberry Metrics Cited byComparative Study of Real‐Life Management Strategies in Gout: Data From Two Protocolized Gout Clinics 6 June 2017Volume 166, Issue 11Page: 855KeywordsAllopurinolDisclosureGoutHealth care qualityPrevention, policy, and public healthRandomized trialsResearch quality assessmentResearch reporting guidelinesTreatment guidelinesUric acid ePublished: 6 June 2017 Issue Published: 6 June 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...