Document Detail


Developing a provisional definition of a flare in patients with established gout.
MedLine Citation:
PMID:  22083456     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: Various non-validated flare criteria have been used in gout studies. Our objective was to develop empirical definitions for a gout flare from patient-reported features. METHODS: Possible elements for flare criteria were previously reported. Data were collected from 210 gout patients at 8 international sites to evaluate potential gout flare criteria against the gold standard of an expert rheumatologist definition. Flare definitions based on the presence of number of criteria independently associated with the flare, and classification and regression tree approaches were developed. RESULTS: The mean age (SD) of the study participants was 56.3 (15) years, 207 (98%) were men, and 54 (26%) patients had gout flares. The presence of any patient-reported warm or swollen joint, pain at rest > 3 on a scale from 0 to 10, and patient-reported flare were independently associated with the study gold standard. The greatest discriminating power was noted for the presence of 3 or more of the above 4 criteria (sensitivity 91%; specificity 82%). Requiring all four criteria provided the highest specificity (96%) and positive predictive value (85%). A classification tree identified pain at rest > 3 followed by patient self-reported flare as the rule associated with the gold-standard (sensitivity 83%; specificity 90%). CONCLUSIONS: We propose definitions for a flare in patients with previously diagnosed gout based on self-reported items. Patient-reported flare, joint pain at rest, presence of warm joints, and swollen joints were most strongly associated with presence of a gout flare. These provisional definitions will next be validated in clinical trials.
Authors:
Angelo L Gaffo; H Ralph Schumacher; Kenneth G Saag; William J Taylor; Janet Dinnella; Ryan Outman; Lang Chen; Nicola Dalbeth; Francisc Sivera; Janitzia Vázquez-Mellado; Chung-Tei Chou; Xuejun Zeng; Fernando Perez-Ruiz; Sergio C Kowalski; Claudia Goldenstein-Schainberg; Lan Chen; Thomas Bardin; Jasvinder A Singh
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-11-14
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  -     ISSN:  1529-0131     ISO Abbreviation:  -     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 by the American College of Rheumatology.
Affiliation:
VA Medical Center. Birmingham, Alabama, USA; Division of Clinical Immunology and Rheumatology. University of Alabama at Birmingham, USA.
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