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Brief Report: Validation of a Definition of Flare in Patients With Established Gout

Research output: Contribution to journalJournal articleResearchpeer-review


  • Angelo L Gaffo
  • Nicola Dalbeth
  • Kenneth G Saag
  • Jasvinder A Singh
  • Elizabeth J Rahn
  • Amy S Mudano
  • Yi-Hsing Chen
  • Ching-Tsai Lin
  • Sandra Bourke
  • Worawit Louthrenoo
  • Janitzia Vazquez-Mellado
  • Hansel Hernández-Llinas
  • Tuhina Neogi
  • Ana Beatriz Vargas-Santos
  • Geraldo da Rocha Castelar-Pinheiro
  • Rodrigo B C Amorim
  • Till Uhlig
  • Hilde B Hammer
  • Maxim Eliseev
  • Fernando Perez-Ruiz
  • Lorenzo Cavagna
  • Geraldine M McCarthy
  • Lisa K Stamp
  • Martijn Gerritsen
  • Viktoria Fana
  • Francisca Sivera
  • William Taylor
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OBJECTIVE: To perform external validation of a provisional definition of disease flare in patients with gout.

METHODS: Five hundred nine patients with gout were enrolled in a cross-sectional study during a routine clinical care visit at 17 international sites. Data were collected to classify patients as experiencing or not experiencing a gout flare, according to a provisional definition. A local expert rheumatologist performed the final independent adjudication of gout flare status. Sensitivity, specificity, predictive values, and receiver operating characteristic (ROC) curves were used to determine the diagnostic performance of gout flare definitions.

RESULTS: The mean ± SD age of the patients was 57.5 ± 13.9 years, and 89% were male. The definition requiring fulfillment of at least 3 of 4 criteria (patient-defined gout flare, pain at rest score of >3 on a 0-10-point numerical rating scale, presence of at least 1 swollen joint, and presence of at least 1 warm joint) was 85% sensitive and 95% specific in confirming the presence of a gout flare, with an accuracy of 92%. The ROC area under the curve was 0.97. The definition based on a classification and regression tree algorithm (entry point, pain at rest score >3, followed by patient-defined flare "yes") was 73% sensitive and 96% specific.

CONCLUSION: The definition of gout flare that requires fulfillment of at least 3 of 4 patient-reported criteria is now validated to be sensitive, specific, and accurate for gout flares, as demonstrated using an independent large international patient sample. The availability of a validated gout flare definition will improve the ascertainment of an important clinical outcome in studies of gout.

Original languageEnglish
JournalArthritis and Rheumatology
Issue number3
Pages (from-to)462-467
Number of pages6
Publication statusPublished - Mar 2018

Bibliographical note


    Research areas

  • Adult, Aged, Cross-Sectional Studies, Female, Gout/diagnosis, Humans, Male, Middle Aged, Sensitivity and Specificity, Severity of Illness Index

ID: 56658859