PT  - JOURNAL ARTICLE
AU  - Taylor, William
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  - Tan, Paul
AU  - Louthreno, Worawit
AU  - Vazquez-Mellado, Janitzia
AU  - Hernández-Llinas, Hansel
AU  - Neogi, Tuhina
AU  - Vargas-Santos, Ana B.
AU  - Castelar-Pinheiro, Geraldo
AU  - Chaves-Amorim, Rodrigo B.
AU  - Uhlig, Tillman
AU  - Hammer, Hilde B.
AU  - Eliseev, Maxim
AU  - Perez-Ruiz, Fernando
AU  - Cavagna, Lorenzo
AU  - McCarthy, Geraldine M.
AU  - Stamp, Lisa K.
AU  - Gerritsen, Martijin
AU  - Fana, Viktoria
AU  - Sivera, Francisca
AU  - Gaffo, Angelo L.
TI  - Flare Rate Thresholds for Patient Assessment of Disease Activity States in Gout
AID  - 10.3899/jrheum.191242
DP  - 2021 Feb 01
TA  - The Journal of Rheumatology
PG  - 293--298
VI  - 48
IP  - 2
4099  - http://www.jrheum.org/content/48/2/293.short
4100  - http://www.jrheum.org/content/48/2/293.full
SO  - J Rheumatol2021 Feb 01; 48
AB  - 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.