Validation of a Definition of Flare in Patients With Established Gout
Por:
Gaffo AL, Dalbeth N, Saag KG, Singh JA, Rahn EJ, Mudano AS, Chen YH, Lin CT, 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 and Taylor W
Publicada:
1 mar 2018
Ahead of Print:
6 feb 2018
Resumen:
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.
Filiaciones:
Gaffo AL:
University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, Alabama
Dalbeth N:
University of Auckland, Auckland, New Zealand
Saag KG:
University of Alabama at Birmingham
Singh JA:
University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, Alabama
Rahn EJ:
University of Alabama at Birmingham
Mudano AS:
University of Alabama at Birmingham
Chen YH:
Taichung Veterans General Hospital, Taichung, Taiwan
Lin CT:
Taichung Veterans General Hospital, Taichung, Taiwan
Bourke S:
University of Auckland, Auckland, New Zealand
Louthrenoo W:
Chiang Mai University, Chiang Mai, Thailand
Vazquez-Mellado J:
Hospital General de Mexico, Mexico City, Mexico
Hernández-Llinas H:
Hospital General de Mexico, Mexico City, Mexico
Neogi T:
Boston University School of Medicine, Boston, Massachusetts
Vargas-Santos AB:
Boston University School of Medicine, Boston, Massachusetts, and Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
da Rocha Castelar-Pinheiro G:
Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
Amorim RBC:
Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
Uhlig T:
Diakonhjemmet Hospital, Oslo, Norway
Hammer HB:
Diakonhjemmet Hospital, Oslo, Norway
Eliseev M:
Research Institute of Rheumatology of Russia, Moscow, Russia
Perez-Ruiz F:
University of the Basque Country, Cruces University Hospital, and Biocruces Health Research Institute, Vizcaya, Spain
Cavagna L:
University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
McCarthy GM:
Mater Misericordiae University Hospital, Dublin, Ireland
Stamp LK:
University of Otago, Christchurch, New Zealand
Gerritsen M:
Westfries Gasthuis, Hoorn, The Netherlands
Fana V:
Rigshospitalet Glostrup, Copenhagen, Denmark
:
Hospital General Universitario Elda, Elda, Spain
Taylor W:
University of Wellington, Wellington, New Zealand
FAFRM Univ Wellington, Wellington, New Zealand.
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