Currently recommended treatment for chronic gout

What is the currently recommended treatment for chronic gout?

George Nuki: Both the European and the British society evidence-based guidelines would suggest that allopurinol is the first-line treatment but it should be started at a low dose, 100 mg a day, lower in people with renal insufficiency, and gradually increased until the target is reached.

There is some difference of opinion as to what the target should be. Everybody agrees that the most conservative target should be a uric acid level below 360 µmol/L, 6 mg/dL. The American and the European guidelines suggest that only in people with more severe manifestations of polyarticular gout with a very high urate level one should aim to go for the lower target of 300 µmol/L, or 5 mg/dL. The British guidelines say that you should go for the lower one altogether.

But I think that most people are agreed at the moment that as a precautionary principle you should not reduce the dose of urate to very low levels – well below 300 µmol/L – for a prolonged period of time because of uncertainty as to whether that might actually be important in aggravating certain neurological disorders such as Parkinson disease.