The Evolving Landscape of Gout in the Female: A Narrative Review

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 Abstract 

 prevalence in females

 landscape of gout in women

It would be better if the authors could unify the term either “females “or “women”

We have unified the terms as ‘male(s)’ and ‘female(s)’ in our revised manuscript.

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Abstract

 women. Significantly, 18 women with gout also have poorer COVID-19 outcomes than do men.

The abstract should include a summary of the relevant information which should cope with the title 

The poorer outcome of COVID-19 specifically in female gout patients might convey important and relevant information about unique traits of female gout, and not just immunity and inflammation in females. However, we agree that this is a gray area, so we removed mention of COVID-19 in the abstract and also took mention of it out of the concluding paragraph of the review.

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Introduction 

Although the introduction gives important data about gout .The authors failed to cover the research gap at the end of the introduction section 

Also,I think it would be better if the authors gave an idea about gout in females and the studies that covered the same point .

We thank the referee for the helpful comments.

Regarding previous studies in female gout, we already mentioned and cited tens of articles in the introduction section. In addition, we have added other studies reporting clinical aspects of female gout in our revised manuscript.

Accordingly, we have added sentences in the introduction section as follows:

Different clinical characteristics in female gout have been reported [6,47,50]. However, the precise mechanisms that drive these sexual differences still remains to be elucidated.

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The literature cited emphasizes relevant manuscripts of the 56 last 7 years, chosen from MEDLINE English language literature searches.

It would be better if the authors added a materials and methods section and gave in detail how they conducted the search.

Because this is not a systematic review, we didn’t put a separate methods section. However, we have added sentences explaining our search strategy in the introduction section as follows:

The literature cited was chosen from MEDLINE English language literature searches. The search strategy aimed to identify relevant papers published, particularly but not exclusively for the last 7 years,  on gout, urate handling, and sex differences, using combination terms of ‘gout’, ‘sex’, ‘women’, ’uric acid’, ’female’.

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Mechanisms that Decrease the Gout and Hyperuricemia

I think that a graph illustrating the text would be more appropriate and interesting to the readers 

We thank the referee for the helpful comment. Because the mechanisms we provide here doesn’t involve much about numbers and statistics, we don’t think a graph is needed. We already have a summary table 1 for the urate transporters which should be helpful enough for the readers.

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Also, it should be noted there are limitations in choosing anti-inflammatory drugs (e.g. non-steroidal anti-inflammatory drugs) for acute flares [

The authors should explain this point 

The sentence is in line with the previous sentence mentioning higher AHS in women partially because of higher CKD prevalence compared to men. To avoid confusion, we have added ‘in the CKD population’ at the end of the sentence.