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

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

doi:10.1002/art.40381

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

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-RuizLorenzo Cavagna, Geraldine M McCarthy, Lisa K Stamp, Martijn Gerritsen, Viktoria Fana, Francisca Sivera, William Taylor

Department for Rheumatology and Spine Diseases

Abstract

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 language	English
Journal	Arthritis and Rheumatology
Volume	70
Issue number	3
Pages (from-to)	462-467
Number of pages	6
ISSN	2326-5191
DOIs	https://doi.org/10.1002/art.40381
Publication status	Published - Mar 2018

Keywords

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

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Gaffo, A. L., Dalbeth, N., Saag, K. G., Singh, J. A., Rahn, E. J., Mudano, A. S., Chen, Y.-H., Lin, C.-T., Bourke, S., Louthrenoo, W., Vazquez-Mellado, J., Hernández-Llinas, H., Neogi, T., Vargas-Santos, A. B., da Rocha Castelar-Pinheiro, G., Amorim, R. B. C., Uhlig, T., Hammer, H. B., Eliseev, M., ... Taylor, W. (2018). Brief Report: Validation of a Definition of Flare in Patients With Established Gout. Arthritis and Rheumatology, 70(3), 462-467. https://doi.org/10.1002/art.40381

Gaffo, AL, Dalbeth, N, Saag, KG, Singh, JA, Rahn, EJ, Mudano, AS, Chen, Y-H, Lin, C-T, Bourke, S, Louthrenoo, W, Vazquez-Mellado, J, Hernández-Llinas, H, Neogi, T, Vargas-Santos, AB, da Rocha Castelar-Pinheiro, G, Amorim, RBC, Uhlig, T, Hammer, HB, Eliseev, M, Perez-Ruiz, F, Cavagna, L, McCarthy, GM, Stamp, LK, Gerritsen, M, Fana, V, Sivera, F & Taylor, W 2018, 'Brief Report: Validation of a Definition of Flare in Patients With Established Gout', Arthritis and Rheumatology, vol. 70, no. 3, pp. 462-467. https://doi.org/10.1002/art.40381

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title = "Brief Report: Validation of a Definition of Flare in Patients With Established Gout",

abstract = "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.",

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

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year = "2018",

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doi = "10.1002/art.40381",

language = "English",

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pages = "462--467",

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issn = "2326-5191",

publisher = "John Wiley and Sons Ltd",

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TY - JOUR

T1 - Brief Report

T2 - Validation of a Definition of Flare in Patients With Established Gout

AU - Gaffo, Angelo L

AU - Dalbeth, Nicola

AU - Saag, Kenneth G

AU - Singh, Jasvinder A

AU - Rahn, Elizabeth J

AU - Mudano, Amy S

AU - Chen, Yi-Hsing

AU - Lin, Ching-Tsai

AU - Bourke, Sandra

AU - Louthrenoo, Worawit

AU - Vazquez-Mellado, Janitzia

AU - Hernández-Llinas, Hansel

AU - Neogi, Tuhina

AU - Vargas-Santos, Ana Beatriz

AU - da Rocha Castelar-Pinheiro, Geraldo

AU - Amorim, Rodrigo B C

AU - Uhlig, Till

AU - Hammer, Hilde B

AU - Eliseev, Maxim

AU - Perez-Ruiz, Fernando

AU - Cavagna, Lorenzo

AU - McCarthy, Geraldine M

AU - Stamp, Lisa K

AU - Gerritsen, Martijn

AU - Fana, Viktoria

AU - Sivera, Francisca

AU - Taylor, William

N1 - COPECARE

PY - 2018/3

Y1 - 2018/3

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Cross-Sectional Studies

KW - Female

KW - Gout/diagnosis

KW - Humans

KW - Male

KW - Middle Aged

KW - Sensitivity and Specificity

KW - Severity of Illness Index

U2 - 10.1002/art.40381

DO - 10.1002/art.40381

M3 - Journal article

C2 - 29161469

SN - 2326-5191

VL - 70

SP - 462

EP - 467

JO - Arthritis and Rheumatology

JF - Arthritis and Rheumatology

IS - 3

ER -

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

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Keywords

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