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Research ArticleGout

Flare Rate Thresholds for Patient Assessment of Disease Activity States in Gout

William Taylor, Nicola Dalbeth, Kenneth G. Saag, Jasvinder A. Singh, Elizabeth J. Rahn, Amy S. Mudano, Yi-Hsing Chen, Ching-Tsai Lin, Paul Tan, Worawit Louthreno, Janitzia Vazquez-Mellado, Hansel Hernández-Llinas, Tuhina Neogi, Ana B. Vargas-Santos, Geraldo Castelar-Pinheiro, Rodrigo B. Chaves-Amorim, Tillman Uhlig, Hilde B. Hammer, Maxim Eliseev, Fernando Perez-Ruiz, Lorenzo Cavagna, Geraldine M. McCarthy, Lisa K. Stamp, Martijin Gerritsen, Viktoria Fana, Francisca Sivera and Angelo L. Gaffo
The Journal of Rheumatology February 2021, 48 (2) 293-298; DOI: https://doi.org/10.3899/jrheum.191242
William Taylor
1W. Taylor, MBChB, PhD, FRACP, FAFRM, University of Otago, Wellington, New Zealand;
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Nicola Dalbeth
2N. Dalbeth, MBChB, MD, FRACP, P. Tan, University of Auckland, Auckland, New Zealand;
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Kenneth G. Saag
3K.G. Saag, MD, MSc, E.J. Rahn, PhD, A.S. Mudano, MPH, University of Alabama at Birmingham, Birmingham, Alabama, USA;
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Jasvinder A. Singh
4J.A. Singh, MD, MPH, A.L. Gaffo, MD, MSPH, University of Alabama at Birmingham, and Birmingham VA Medical Center, Birmingham, Alabama, USA;
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Elizabeth J. Rahn
3K.G. Saag, MD, MSc, E.J. Rahn, PhD, A.S. Mudano, MPH, University of Alabama at Birmingham, Birmingham, Alabama, USA;
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Amy S. Mudano
3K.G. Saag, MD, MSc, E.J. Rahn, PhD, A.S. Mudano, MPH, University of Alabama at Birmingham, Birmingham, Alabama, USA;
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Yi-Hsing Chen
5Y.H. Chen, MD, PhD, C.T. Lin, MD, Taichung Veterans General Hospital, Taichung, Taiwan;
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Ching-Tsai Lin
5Y.H. Chen, MD, PhD, C.T. Lin, MD, Taichung Veterans General Hospital, Taichung, Taiwan;
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Paul Tan
2N. Dalbeth, MBChB, MD, FRACP, P. Tan, University of Auckland, Auckland, New Zealand;
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Worawit Louthreno
6W. Louthreno, MD, Chiang Mai University, Chiang Mai, Thailand;
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Janitzia Vazquez-Mellado
7J. Vazquez-Mellado, MD, PhD, H. Hernández-Llinas, MD, Hospital General de Mexico, Mexico City, Mexico;
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Hansel Hernández-Llinas
7J. Vazquez-Mellado, MD, PhD, H. Hernández-Llinas, MD, Hospital General de Mexico, Mexico City, Mexico;
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Tuhina Neogi
8T. Neogi, MD, PhD, FRCPC, A.B. Vargas-Santos, MD, Boston University School of Medicine, Boston, Massachusetts, USA;
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  • ORCID record for Tuhina Neogi
Ana B. Vargas-Santos
8T. Neogi, MD, PhD, FRCPC, A.B. Vargas-Santos, MD, Boston University School of Medicine, Boston, Massachusetts, USA;
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Geraldo Castelar-Pinheiro
9G. Castelar-Pinheiro, MD, PhD, R.B. Chaves-Amorim, MD, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil;
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Rodrigo B. Chaves-Amorim
9G. Castelar-Pinheiro, MD, PhD, R.B. Chaves-Amorim, MD, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil;
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Tillman Uhlig
10T. Uhlig, MD, H.B. Hammer, MD, PhD, Diakonhjemmet Hospital, Oslo, Norway;
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Hilde B. Hammer
10T. Uhlig, MD, H.B. Hammer, MD, PhD, Diakonhjemmet Hospital, Oslo, Norway;
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Maxim Eliseev
11M. Eliseev, PhD, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia;
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Fernando Perez-Ruiz
12F. Perez-Ruiz, MD, PhD, Servicio de Reumatologia, Baracaldo, Spain;
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Lorenzo Cavagna
13L. Cavagna, MD, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy;
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Geraldine M. McCarthy
14G.M. McCarthy, MD, FRCPI, Mater Misericordiae University Hospital, Dublin, Ireland;
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Lisa K. Stamp
15L.K. Stamp, MBChB, FRACP, PhD, University of Otago-Christchurch, Christchurch, New Zealand;
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Martijin Gerritsen
16M. Gerritsen, MD, PhD, Westfries Gasthuis, Hoorn, the Netherlands;
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Viktoria Fana
17V. Fana, MD, Copenhagen Center for Artritis Reserch, Righospitalet Glostrup, Denmark;
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Francisca Sivera
18F. Sivera, MD, PhD, Hospital General Universitario Elda, Elda, Spain.
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Angelo L. Gaffo
4J.A. Singh, MD, MPH, A.L. Gaffo, MD, MSPH, University of Alabama at Birmingham, and Birmingham VA Medical Center, Birmingham, Alabama, USA;
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  • For correspondence: agaffo@uabmc.edu
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Abstract

Objective. To determine the relationship between gout flare rate and self-categorization into remission, low disease activity (LDA), and patient acceptable symptom state (PASS).

Methods. Patients with gout self-categorized as remission, LDA, and PASS, and reported number of flares over the preceding 6 and 12 months. Multinomial logistic regression was used to determine the association between being in each disease state (LDA and PASS were combined) and flare count, and self-reported current flare. A distribution-based approach and extended Youden index identified possible flare count thresholds for each state.

Results. Investigators from 17 countries recruited 512 participants. Remission was associated with a median recalled flare count of zero over both 6 and 12 months. Each recalled flare reduced the likelihood of self-perceived remission compared with being in higher disease activity than LDA/PASS, by 52% for 6 months and 23% for 12 months, and the likelihood of self-perceived LDA/PASS by 15% and 5% for 6 and 12 months, respectively. A threshold of 0 flares in preceding 6 and 12 months was associated with correct classification of self-perceived remission in 58% and 56% of cases, respectively.

Conclusion. Flares are significantly associated with perceptions of disease activity in gout, and no flares over the prior 6 or 12 months is necessary for most people to self-categorize as being in remission. However, recalled flare counts alone do not correctly classify all patients into self-categorized disease activity states, suggesting that other factors may also contribute to self-perceived gout disease activity.

Key Indexing Terms:
  • disease activity
  • gout
  • remission
  • Accepted for publication April 21, 2020.
  • Copyright © 2021 by the Journal of Rheumatology
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1 Feb 2021
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Flare Rate Thresholds for Patient Assessment of Disease Activity States in Gout
William Taylor, Nicola Dalbeth, Kenneth G. Saag, Jasvinder A. Singh, Elizabeth J. Rahn, Amy S. Mudano, Yi-Hsing Chen, Ching-Tsai Lin, Paul Tan, Worawit Louthreno, Janitzia Vazquez-Mellado, Hansel Hernández-Llinas, Tuhina Neogi, Ana B. Vargas-Santos, Geraldo Castelar-Pinheiro, Rodrigo B. Chaves-Amorim, Tillman Uhlig, Hilde B. Hammer, Maxim Eliseev, Fernando Perez-Ruiz, Lorenzo Cavagna, Geraldine M. McCarthy, Lisa K. Stamp, Martijin Gerritsen, Viktoria Fana, Francisca Sivera, Angelo L. Gaffo
The Journal of Rheumatology Feb 2021, 48 (2) 293-298; DOI: 10.3899/jrheum.191242

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Flare Rate Thresholds for Patient Assessment of Disease Activity States in Gout
William Taylor, Nicola Dalbeth, Kenneth G. Saag, Jasvinder A. Singh, Elizabeth J. Rahn, Amy S. Mudano, Yi-Hsing Chen, Ching-Tsai Lin, Paul Tan, Worawit Louthreno, Janitzia Vazquez-Mellado, Hansel Hernández-Llinas, Tuhina Neogi, Ana B. Vargas-Santos, Geraldo Castelar-Pinheiro, Rodrigo B. Chaves-Amorim, Tillman Uhlig, Hilde B. Hammer, Maxim Eliseev, Fernando Perez-Ruiz, Lorenzo Cavagna, Geraldine M. McCarthy, Lisa K. Stamp, Martijin Gerritsen, Viktoria Fana, Francisca Sivera, Angelo L. Gaffo
The Journal of Rheumatology Feb 2021, 48 (2) 293-298; DOI: 10.3899/jrheum.191242
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Keywords

DISEASE ACTIVITY
GOUT
REMISSION

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Keywords

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  • gout
  • remission

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