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I read with interest the manuscipt by Jeyaruban and colleagues.
However I am disappointed that a major issue identified was a "Failure of
adherence to lifestyle changes".
There is scant evidence that lifestyle changes have any clinically
relevant impact on gout management.
Surgical weight loss is one of the few non medication related
interventions that has a substantial impact on serum urate.
The American College of Rheumatology recognised this in the 2012 ACR
Gout guidelines by saying "the TFP [Task Force Panel] recognized that diet
and lifestyle measures alone provide therapeutically insufficient serum
urate-lowering effects and/or gout attack prophylaxis for a large fraction
of individuals with gout".
One of the problems with lack of high quality gout care in Australia
in my opinion is the undue emphasis on non-evidence based interventions,
that, even if effective (which they have not shown to be yet), have a
small effect size. This is often to the detriment of emphasis on effective
evidence based therapies (all of which are currently medication based).
A focus on effective evidence based therapies would likely lead to a
better level of gout care by all involved with caring for these patients.
Menarini and AstraZeneca (Research Funding and Speaking)