To the Editor Dr Wallach and colleagues evaluated the association between surrogate markers listed in the FDA surrogate end point table and clinical outcomes for 32 chronic diseases, including gout. In accordance with 2 published meta-analyses, the authors concluded urate levels are a weak surrogate marker for gout flares. They also indicated that reducing urate levels may worsen pain in people with gout. An explanation of these findings is needed to avoid confusion in gout management.
