OPEN LETTER OF SUPPORT PROFESSOR THOMAS BARDIN

Supporting the Call for Consensus: Formally Incorporating the “Goal of Curing Gout” into Updated Guideline Versions

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

I am writing to express my support for the Call for Consensus initiated by Vien Gut: to formally incorporate the “goal of curing gout” as a central treatment goal in updated guideline versions, thereby advancing a consensus process that can be implemented in real-world practice.

As a contributor to the academic development of EULAR recommendations for gout management, I am also a strong supporter of the view that gout is curable through its crystal-based mechanism. When serum uric acid is lowered below the saturation threshold and maintained for a sufficient duration, urate crystals stop forming and gradually dissolve. In essence, once the crystal deposits no longer exist, gout has reached a state of “cure” that can be defined through clear criteria.

However, the current paradox is not a lack of mechanistic evidence. The paradox lies in the fact that the treatment system has not positioned “crystal-free” status as the central operational endpoint. When this central goal is not clearly defined and prioritized in guidelines, clinical practice tends to stop at the target of remission, as proposed by OMERACT in 2016 and further reinforced by G-CAN in 2024, rather than progressing toward the ultimate endpoint: complete dissolution of urate crystals—achieving a verifiable gout cure that can be sustained through long-term follow-up.

Therefore, I support the Forum’s key direction: unlocking the three-part foundation—principle → goal → criteria. Guidelines have already played the role of establishing the principle; the next step is to formally adopt the goal of cure, to pave the way for:

  1. standardizing verification criteria and outcomes;

  2. designing appropriate research;

  3. building scalable long-term outpatient operational models.

I respectfully call on colleagues to participate in this consensus process, especially: (i) guideline update groups, and (ii) a Working Group in collaboration with OMERACT to elevate existing criteria into measurable and verifiable criteria for “conditional gout cure.”

Respectfully,

Professor Thomas Bardin
(Co-author of the EULAR recommendations on gout management)