THE BIGGEST PARADOX AND REAL-WORLD CLINICAL DIFFICULTIES

Although the principle that gout is curable has been affirmed with absolute consistency in 18 international guidelines for nearly 20 years, the biggest paradox is this: the goal of curing gout has still not been defined as the central destination in any guideline. As a result, clinicians face countless day-to-day difficulties, and patients—especially those with severe complicated gout—fall into a genuine deadlock.

These difficulties reflect real-world practice that most of us experience:

Difficulty in convincing patients to stay on lifelong urate-lowering therapy (ULT)

After acute inflammation and pain flares stop recurring, patients often ask: “I’m already cured—why do I still need to take medication forever?” Because guidelines do not formally define “cure” as an official destination, clinicians are often forced to speak in general terms such as “chronic management,” which leads to poor adherence, discontinuation, and repeated relapse cycles. 

Difficulty explaining early flare-ups caused by the crystal dissolution process

In the initial phase of ULT, flare-ups often occur due to mobilization of crystals. Patients become confused and distressed: “This medicine is making my pain worse!” This easily erodes trust and leads to treatment discontinuation. Without a unified “destination language” from guidelines, clinicians must rely on personal explanations—resulting in inconsistent messaging across providers. 

Deadlock in managing severe complicated gout with complex chronic multimorbidity

This patient group (large tophi, chronic kidney disease, cardiovascular disease, diabetes, etc.) requires integrated longitudinal follow-up, a multidisciplinary team, and careful dose adjustment of ULT. But when guidelines do not officially orient the journey toward the goal of cure, clinicians are forced to “fight alone” against overlapping complications—while patients fall into a real deadlock: prolonged relapses, severely reduced quality of life, and uncontrolled complications.

Difficulty when medical communication has not officially supported the cure-oriented message

Today, medical communication still mainly frames gout as “a chronic disease that must be managed for life,” lacking the positive and accurate message of “conditionally curable.” Clinicians lack a unified “destination language” to communicate to patients, resulting in low long-term motivation on both sides.