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SUA levels should not be maintained < 3 mg/dL for several years. Response to ‘EULAR gout treatment guidelines by Richette et al: uric acid and neurocognition by Singh et al’
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 ♥ mg/dL (<180 µmol/L) is not recom…
At diagnosis, Gout should be treated aggressively and promptly to target a serum uric acid level well below its crystallization concentration of 6.8 mg% at core body temperature. The conventional target is 6 mg%.
However, in the cooler peripheries, and in the presence of nucleation framework (old injuries, existing tophi), precipitation may well occur at lower serum concentrations. I thus advocate 5 mg%.
The lower you go, the faster you’ll clear the deposits and the total body urate burden. But there are concerns, both theoretical and evidential, that, maintaining too low (below 3 mg%) a target may prove detrimental in the long run. As in all things, moderation is the better part of prudence.