[The Dutch College of General Practitioners' "Gout" Standard: a response from general practitioners]

Although gout has a long nosological history, there are still many uncertainties regarding its pathophysiology, causative factors and most common therapies. Therefore, composing an evidence-based guideline on gout is a challenge. There is a lack of good clinical research, especially in primary care populations where most gout patients are diagnosed and treated. Far more insight is required into the mechanisms which underlie increasing and decreasing serum uric acid levels which, via the blood-synovium barrier, should increase or decrease urate crystals with inflammatory potency. In view of this lack of information, it would have been more appropriate for the Standard not to contain unproven facts and therapeutic recommendations. Guidelines should be kept simple until good clinical research proves the opposite.