OPEN LETTER OF SUPPORT – PROFESSOR NICOLA DALBETH

Supporting the Call for Consensus: Clarifying and Refining the “Central Treatment Target” in Gout

To:
Clinical research experts, guideline development and update groups, and the international medical community,

I am writing to express my support for the scientific dialogue initiated by Vien Gut, with a focus on clarifying the relationship between pathophysiological mechanism, the central treatment target, and outcome criteria in gout.

As a co-author of the ACR recommendations (2012 and 2020), and as a researcher with a strong focus on urate crystal mechanisms, imaging, and the long-term course of gout, I believe this Call for Consensus addresses an important and necessary scientific issue: the gap between mechanistic understanding and how the treatment system defines the “destination” in real-world clinical practice.

From a pathophysiological perspective, gout is a disease of monosodium urate (MSU) crystal deposition. When serum uric acid is lowered below the saturation threshold and maintained long enough, these crystals stop forming and gradually dissolve. This mechanism has been clearly described across many studies and underpins current treatment strategies.

However, in current treatment guidelines, including ACR recommendations, the central treatment target is primarily presented as controlling serum urate and managing gout as a long-term condition, while the concept of “cure” has not been formally designated as a verifiable outcome state. The adoption of targets such as remission has played a major role in standardizing research and practice, but it also raises a legitimate scientific question: is this the final destination—or an intermediate milestone along the therapeutic journey?

In this spirit, I appreciate that the Forum does not impose a predetermined conclusion. Instead, it calls for an open scientific consensus process to examine whether guideline systems should take the next step: moving from describing gout as “curable in principle” to seriously discussing the conditions, criteria, and verification methods for a real-world gout cure state.

I believe that multi-center scientific dialogue—engaging guideline groups, outcome standardization organizations, and both basic and clinical researchers—offers the most appropriate path to clarify this issue, while ensuring that any progress remains grounded in evidence, feasibility, and patient safety.

Respectfully,

Professor Nicola Dalbeth
(Co-author of the ACR recommendations 2012, 2020)