Tuhina Neogi, MD, PhD; Ted R. Mikuls, MD, MSPH
Grant Support: By grants P60 AR47785 (Dr. Neogi) and P50 AR060772 (Dr. Mikuls) from the National Institutes of Health.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2401.
Requests for Single Reprints: Tuhina Neogi, MD, PhD, Clinical Epidemiology Unit and Rheumatology, Boston University School of Medicine, 650 Albany Street, Suite X200, Boston, MA 02118.
Current Author Addresses: Dr. Neogi: Clinical Epidemiology Unit and Rheumatology, Boston University School of Medicine, 650 Albany Street, Suite X200, Boston, MA 02118.
Dr. Mikuls: Department of Internal Medicine and Division of Rheumatology, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270.
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February 12, 2019
Treat to Moving Target ?
Dear Drs. Neogi and Mikuls,The recommendation to treat gout to target has me confused. Perhaps you can clear up my confusion. It has to do with the variability of the concentration of serum uric acid (SUA) in any individual throughout the diurnal cycle. It is my understanding that the measurement of SUA was deleted from the metabolic blood panel in part because of that variability. I would expect that in an attempt to minimize that variability, a standard needs to be set for the conditions under which blood is taken for the SUA measurement. I am not aware of any such standard. Interestingly, you contrast the measurement of SUA for gout with the measurement of blood sugar for diabetes. Standard conditions for the measurement of blood sugar have been set -- a snapshot taken after a 12 hour fast or with the glucose tolerance test.I am sure that the variability of SUA is even more extreme in gout patients with sleep apnea. The hypoxemia of sleep apnea causes transient spikes in SUA during sleep which dissipate after awakening, and SUA is almost never measured during sleep. It is measured not on the basis of science but on the basis of convenience for the doctor and/or the patient. Until a standard for SUA measurement is set that acceptably minimizes its variability, the treat gout to target approach makes no sense to me.Regards,Burton Abrams
Neogi T, Mikuls TR. To Treat or Not to Treat (to Target) in Gout. Ann Intern Med. ;166:71–72. doi: 10.7326/M16-2401
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Published: Ann Intern Med. 2017;166(1):71-72.
Published at www.annals.org on 1 November 2016
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