Method | Description | No. and Type of Studies with References | Feasibility | Truth | Within-group Discrimination (ES) | Between-group Discrimination (estimate or statistic with p-value) |
---|---|---|---|---|---|---|
Physician assessment of tenderness in the index joint using a 4-point Likert scale (range 0–3) | 0 = no pain; 1 = mild/patient states there is pain when touched, 2 = moderate/patient states there is pain and winces, 3 = severe/patient states there is pain, winces and withdraws | Total: 17, controlled*: 12 (15, 17, 18, 20, 23, 41, 42, 44, 49–52); observational: 5 (54–57, 60) | Inexpensive, some training required, no specialist equipment required, may cause patient distress | High face validity. The reduction in the number of patients with severe or moderate tenderness was accompanied by greater proportion of patients reporting no or mild pain on the 5-point Likert scale, the increasing proportion of patients reporting normalization of C-reactive protein, and better responses from PGART and IGART (18). Unable to calculate correlation coefficients with available information. Patients with both monoarticular and oligoarticular disease had a clinical response, but the response was greater in those with monoarticular disease, p < 0.01 (42). Patients with both moderate and severe/extreme pain at baseline had a clinical response, but the response was greater in those with severe/extreme pain, p < 0.05 (42). Measure captures degree of tenderness in affected joint. | All articles reported significant reduction in joint tenderness scores over time, typically by 72 h. In a clinical trial of 2 doses of piroxicam, mean tenderness score reduced from 2.10 at baseline to 0.54 on Day 3 and 0.15 on Day 7 in the high dose piroxicam group. ES = 2.5 on Day 3 and 2.9 on Day 7 (23). | In an RCT of canakinumab (CAN) vs triamcinolone acetonide (TA), the CAN 150 mg group had a lower tenderness score compared with the TA group 7 days post dose. The odds ratio favoring CAN 150 mg was 3.2 (95% CI, 1.27–7.9) (18). In 2 RCT comparing etoricoxib (ETO) and indomethacin (IND), there is no difference between the least square mean difference in tenderness scores between the ETO and IND groups (17, 20). |
Physician assessment of tenderness in the index joint using Likert 0–4 (5-point scale) | 0 = no tenderness, 1 = mild tenderness, 2 = moderate tenderness, 3 = severe tenderness and 4 = very severe tenderness | Total: 5; controlled: 2 (21, 43); observational: 3 (16, 46, 47) | Inexpensive, some training required, no specialist equipment required, may cause patient distress | High face validity. Reduction in tenderness was accompanied by similar reduction in pain, swelling and restriction of joint movement (21, 46). Unable to calculate correlation coefficients with available information. Measure captures degree of tenderness in affected joint. | All articles reported significant reduction in joint tenderness scores over time, typically by 72 h following treatment. In untreated acute gout, tenderness scores were 3.9 at baseline, (Day 1), 3.9 on Day 2, and 3.1 on Day 7. ES = 0.0 on Day 2; and 0.9 on Day 7 (16). In clinical study of different dosing regimens of intravenous indoprofen, high dose bolus indoprofen lead to reduction of tenderness scores from 3.54 at baseline to 2.54 after 2 h, 1.46 after 4 h, 1.08 after 24 h, and 0.09 after 48 h. The ES from 2, 4, 24, and 48 h after the start of treatment were 2.1, 4.3, 5.1, and 7.2 respectively (21). | In a clinical trial of 2 dosage regimens of indoprofen, there was no difference in the reduction in tenderness between 2 regimens (21). In a clinical trial comparing 2 antiinflammatory agents (IND and proquazone), there was no difference in the reduction in tenderness between 2 agents (43). |
Physician assessment of the number of tender joints (tender joint count, TJC) | Total: 3; controlled: 2 (23, 28); observational: 1 (26) | Inexpensive, some training required, no specialist equipment required, may cause patient distress | The reduction in the TJC was accompanied by reduction in tender joint count, pain VAS score, and C-reactive protein value, Leeds Foot Impact Scale and increase in the mean score of Lower Limb Task Questionnaire (26). Unable to calculate correlation coefficients with available information. Monoarticular flares are common in patients; in an RCT comparing etoricoxib (ETO) and indomethacin (IND), 99/150 patients had a single joint affected (17). Risk of floor effect. Degree of swelling not captured within the measure. | All treatments led to significant reduction in SJC over time, with the exception of the herbal formula Danggui-Nian-Tong-Tang (DNTT) (28). Following IND treatment, mean (SD) SJC reduced from 1.3 (0.7) at baseline to 0.6 (0.5) after 72 h ES = 0.22 (28). In an observational study, mean (SD) SJC reduced from 3 (3) at baseline to 0 (1) at the followup visit (> 1 month after treatment). ES = 0.67 (26). | In an RCT comparing DNTT with IND, there was a significant difference between the groups in TJC after 72 h of treatment; mean (SD) TJC for DNTT 2.6 (2.4), and IND 0.6 (0.7), p = 0.001 (28). In an RCT of 2 dosage regimens of piroxicam, there was no significant difference in TJC between high-dose and low-dose piroxicam (23). |
↵* Navarra reference was posthoc analysis of Rubin and Schumacher studies. PGART: patient global assessment of response to treatment; IGART: investigator global assessment of response to treatment; VAS: visual analog scale; RCT: randomized controlled trial.