McGill is to be commended for his recent review of the treatment of gout. In Australia, allopurinol remains the most widely used urate lowering therapy and it is noteworthy that McGill draws attention to the fact that the common acceptance and usage of <=300 mg daily is inadequate in the majority of patients. This dose has had a strong historical precedent2-3 despite the well-accepted target for serum urate of at least <0.36 mmol/L in patients with recurrent gout. It should be recognized that this target has as much or more to do with prevention and treatment of tophi as it has to do with the prevention of acute attacks of gout: any lowering of urate decreases the risk of acute attacks, and other drugs such as colchicine decrease the frequency of acute attacks.
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