Is optimising gout treatment the key to closing the mortality gap in gout patients

With great interest we read the extended report of Fisher et al 1 on the unclosing premature mortality gap in gout and we congratulate the authors on their extensive work. In their population-based cohort study, the authors found that among the patients with gout, the level of premature mortality remained unimproved over the past 16 years. However, there are a few issues that, in our opinion, merit attention concerning the conclusions that were drawn from the data: 1. The authors hypothesise that proper urate control could have cardiovascular–metabolic–renal benefits, and thus optimising gout treatment would reduce mortality. However, the authors have chosen ‘all-cause mortality’ as their outcome, most likely because disease-related mortality was not available.2 In rheumatoid arthritis (RA), the main cause for premature mortality is cardiovascular death, with poor clinical RA status prognostic of premature mortality, and thus the closing mortality gap may very well be due to tighter disease …