The time is overdue for new definitions of the ‘stages’ of gout, a Canadian rheumatologist says in a letter which we think is a real contender for this year’s best headline (but maybe we need to get out more).

In a letter headed ‘ungoutedly time for a change’ Graham Reid from the University of British Columbia in Canada says a report by Nicola Dalbeth and colleagues published earlier this year on dual-energy CT (DECT) in patients with asymptomatic hyperuricaemia and symptomatic gout “reinforces the need to change our terminology, classification and management guidelines for gout”.

All current guidelines for the management of gout advise starting urate-lowering therapies for patients with tophi (urate deposits) but Dalbeth and her colleagues had shown that urate deposits can be demonstrated by DECT scanning in patients with hyperuricaemia who have never experienced an acute episode of joint inflammation.

“Tophi are urate deposits whether we can see them clinically or need a DECT scan. Does this mean that all patients with urate deposits on DECT scanning need urate-lowering therapy as the current guidelines suggest or are the guidelines not applicable in this setting?” Reid asked in his letter published in the Annals of the Rheumatic Diseases.

 DECT scanning is a very useful tool for demonstrating urate deposits but will have lesser value in assessment of an acute episode of joint inflammation, says Reid.

“The time is overdue for new definitions of the ‘stages’ of gout, so that there is effective communication of information from the increasing number of research studies.”