MÔ THƯ NGỎ ỦNG HỘ (ENDORSEMENT LETTER)

To:

The World Health Organization (WHO),
The Organisation for Economic Co-operation and Development (OECD),
and the international scientific community,

My name is Thomas Bardin, MD, Professor of Medicine, Member of the French Academy of Medicine, specializing in Rheumatology. I have more than 40 years of experience in the research and treatment of gout and am a co-author of the EULAR gout management guidelines since 2006.

Across multiple international guidelines—from EULAR 2006, ACR 2020, to ÖGR 2022—the view that gout is a potentially curable disease has been consistently articulated, based on its pathophysiology: if serum uric acid levels are lowered and maintained below the target threshold for a sufficient duration, the formation of new urate crystals can be prevented and existing deposits can be dissolved. I and many of my colleagues strongly support this position from a scientific standpoint. However, for various systemic reasons, current guidelines have not yet formally operationalized “cure” as a practical standard jointly pursued by physicians and patients.

I began research collaboration with Vien Gut in July 2014. What particularly drew my attention was not that Vien Gut proposed a new mechanistic concept, but rather how it addressed the implementation gap of guideline-based medicine in real-world clinical practice. Vien Gut began with patients suffering from severe, complicated gout—cases that often fall outside the operational coverage of existing guidelines—and was therefore compelled to develop a structured integrated outpatient care model to ensure safe and effective treatment.

Through this collaboration, I have observed that the operational layer of the Vien Gut Model – Integrated Outpatient Care for Complex Chronic Multimorbidity—including time-structured treatment organization, multidisciplinary teams, longitudinal data monitoring, risk stratification, polypharmacy governance, and a bidirectional referral “safety valve” mechanism—has made the application of guideline-based therapeutic principles feasible in complex clinical contexts. This operational layer enables sustained lowering of serum uric acid below the saturation threshold, complete dissolution of deposited urate crystals, elimination of tophi, and the achievement of a verifiable state of gout remission or cure, rather than remaining a theoretical expectation within guidelines.

When Vien Gut expanded the model to disease groups beyond my direct area of expertise—including end-stage chronic kidney disease prior to dialysis, chronic heart failure, and decompensated cirrhosis—I agreed with Vien Gut on the necessity of involving additional French specialists from the relevant fields for collaborative research. My colleagues have noted that the treatment outcomes and operational capacity of the model are remarkable and concur that independent validation on a larger scale is warranted.

In the context of the growing global burden of complex chronic multimorbidity, particularly in low- and middle-income countries, I consider Vien Gut’s initiative to share its model and to propose scientific dialogue with WHO, OECD, and the international community to be both serious and valuable. I support the initiation of technical dialogues aimed at clarifying implementation conditions, evaluation criteria, and the transferability of this model.

As a clinician and researcher in the field of gout, I highly appreciate Vien Gut’s efforts to translate a scientifically sound concept—“gout is curable”—into a structured, disciplined, and verifiable real-world practice pathway, even for patients with severe complications. This represents a contribution that deserves serious consideration by the international scientific community.

Respectfully,

Professor Thomas Bardin, MD
Professor of Medicine
Member of the French Academy of Medicine
Specialist in Rheumatology