The challenge of gout flare measurement

Stewart, Sarah; Dalbeth, Nicola; Gaffo, Angelo L.

doi:10.1016/j.berh.2021.101716

Cited by 3 publications

(3 citation statements)

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“…Additionally, the recurrence of gout is unpredictable, and the chances of experiencing repeated flare-ups are influenced by the severity of hyperuricemia ( 6 ). AGA attacks cause immense, intolerable pain to the patient and, due to their unpredictability, severely affect activities of daily living, mood, and social functioning ( 7 , 8 ). The distress caused by the pain to the patient was found to be immense, especially the severe pain during severe flare-ups, which almost completely limits the possibility of walking and standing and can cause more distress in the knee than in other small joints.…”

Section: Introductionmentioning

confidence: 99%

Electroacupuncture for acute gouty arthritis: a systematic review and meta-analysis of randomized controlled trials

Ni,

Xiao,

Xia

et al. 2024

Front. Immunol.

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Acute gouty arthritis (AGA) is a metabolic disorder in which recurrent pain episodes can severely affect the quality of life of gout sufferers. Electroacupuncture (EA) is a non-pharmacologic therapy. This systematic review aimed to assess the efficacy and safety of electroacupuncture in treating acute gouty arthritis. We searched eight Chinese and English databases from inception to July 30, 2023, and 242 studies were retrieved. Finally, 15 randomized controlled trials (n=1076) were included in a meta-analysis using Review Manager V.5.4.1. meta-analysis results included efficacy rate, visual rating scale (VAS) for pain, serum uric acid level (SUA), immediate analgesic effect, and incidence of adverse events. Electroacupuncture (or combined non-pharmacologic) treatment of AGA was significantly different from treatment with conventional medications (RR = 1.14, 95% confidence interval CI = 1.10 to 1.19, P < 0.00001). The analgesic effect of the electroacupuncture group was superior to that of conventional Western drug treatment (MD = -2.26, 95% CI = -2.71 to -1.81, P < 0.00001). The electroacupuncture group was better at lowering serum uric acid than the conventional western drug group (MD =-31.60, CI -44.24 to -18.96], P < 0.00001). In addition, electroacupuncture combined with Western drugs had better immediate analgesic effects than conventional Western drug treatment (MD = -1.85, CI -2.65 to -1.05, P < 0.00001). Five studies reported adverse events in the electroacupuncture group versus the drug group, including 19 cases of gastrointestinal symptoms and 6 cases of neurological symptoms (RR = 0.20, 95% CI = 0.04 to 0.88, P = 0.03).Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=450037, identifier CRD42023450037.

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Section: Introductionmentioning

confidence: 99%

Electroacupuncture for acute gouty arthritis: a systematic review and meta-analysis of randomized controlled trials

Ni,

Xiao,

Xia

et al. 2024

Front. Immunol.

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“…The outcome ascertainment of gout flares was only captured during clinical encounters, but, in clinical practice, an important proportion of flares are self-managed by patients or only reported retrospectively. 11 In this regard, the analysis of gout flare hospitalizations is particularly powerful and reassuring, as hospitalized gout flares have a much better classification accuracy. 12 Interestingly, with most of these biases and with a population on the mild end of the gout severity spectrum, the expected outcome would be a trend toward a null association as opposed to the results of this study.…”

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confidence: 99%

“…The serum urate exposure ascertainment was based on a single measurement, which can be affected by physiological fluctuations and is expected to be less accurate as an anchor variable for long-term associations. The outcome ascertainment of gout flares was only captured during clinical encounters, but, in clinical practice, an important proportion of flares are self-managed by patients or only reported retrospectively . In this regard, the analysis of gout flare hospitalizations is particularly powerful and reassuring, as hospitalized gout flares have a much better classification accuracy .…”

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confidence: 99%

Serum Urate and Its Association With Gout Flares

Gaffo

2024

JAMA

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Gout is a chronic illness that has been underappreciated and poorly understood. Despite being more prevalent than rheumatoid arthritis and lupus, 1,2 gout has traditionally lagged behind these other diseases in research and quality of care. In addition, poor clinical management of gout is associated with increased cardiovascular morbidity and mortality, chronic kidney disease, and metabolic syndrome. These associations have been described as forming part of a comorbidity cluster in need of treatment optimization. 3 The intensely painful attacks of inflammatory arthritis known as gout flares are the main clinical manifestation of the disease, and their decrease in frequency and intensity is what matters most to patients. 4 Elevated serum urate levels above the saturation point (6.8 mg/dL at 37 °C, the definition of hyperuricemia) and the deposition of monosodium urate crystals in joints and periarticular tissues lead to activation of the innate immune system and the acute arthritis characteristic of gout. 5 Since the role of the uric acid molecule was recognized in the pathogenesis of gout, an association between circulating serum urate levels and clinical manifestations of gout was assumed. However, the evidence to support this assumption has been scarce. This issue became more controversial when the clinical guidelines for gout management were updated and were contradictory to the major rheumatology recommendations, which were still based on treating to a serum urate target using urate-lowering therapies. [6][7][8] Since then, concerns about the value of serum urate as a biomarker for gout severity and treatment response have increased, despite serum urate being used for decades for this purpose in the rheumatology practice community. Consequently, the need to generate evidence about the best strategy for secondary prevention of gout clinical manifestations is a priority.In this issue of JAMA, McCormick et al used data from the UK Biobank to study the association between a baseline level of serum urate and the subsequent risk of flares among 3613 patients with gout followed up for a mean of 8.3 years. 9 The primary analysis used a reference serum urate category of less than 6 mg/dL (the treat-to-target threshold recommended by most treatment guidelines) and studied the rate ratios of gout flares associated with 1.0-mg/dL increase categories over the reference value up to 10 mg/dL or higher. The results showed that all the categories above 6 mg/dL were associated with significantly increased rate ratios of gout flares, starting with 3.37 for the 6.0 to 6.9 mg/dL category up to 11.42 for the 10 mg/dL or higher category. These increased rate ratio associations did not vary meaningfully

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Towards a patient-centred definition for atopic dermatitis flare: a qualitative study of adults with atopic dermatitis

Dainty,

Thibau,

Amog

et al. 2024

British Journal of Dermatology

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Background The term “flare” is used across multiple diseases, including atopic dermatitis (AD), to describe increased disease activity. While several definitions of an AD flare have been proposed, no single definition of AD flare is widely accepted, and it is unclear what the term AD flare means from the patient perspective. Objectives The objectives of this qualitative study were to understand AD flares from the adult patient perspective and to explore how adult AD patients define an AD flare. Methods Participants were adults with atopic dermatitis recruited from the National Eczema Association (NEA) Ambassadors Program, a volunteer patient engagement program. They participated in online focus groups to discuss how they describe AD flares from their perspective, how they define its start and stop, and how they relate to existing definitions of flare. Using a grounded theory approach, transcripts were analyzed and coded using an iterative process to identify concepts to support a patient-centered conceptual framework of “flare.” Results Six 90-minute focus groups of 3-8 participants each were conducted with 29 US adult (≥18 years) AD patients who had at least one self-reported AD flare in the past year. When participants were presented with examples of previously published definitions of AD flare, participants found them problematic and unrelatable. Specifically, they felt that flare is hard to quantify or put on a numeric scale, definitions cannot solely be about skin symptoms, and clinical verbiage does not resonate with patients’ lived experiences. Concepts identified by patients as important to a definition of flare were changes from patient’s baseline/patient’s normal, mental/emotional/social consequences, physical changes in skin, attention needed/all-consuming focus, itch-scratch-burn cycle, and control/loss of control/quality of life. Figuring out the trigger that initiated a flare was an underlying concept of the experience of flare, but not considered a contributor to the definition. Conclusions The results highlight the complexity and diversity of AD flare experiences from the adult patient perspective. Previously published definitions of AD flares did not resonate with patients, suggesting a need for a patient-centered flare definition to support care conversations and AD management.

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The challenge of gout flare measurement

Cited by 3 publications

References 50 publications

Electroacupuncture for acute gouty arthritis: a systematic review and meta-analysis of randomized controlled trials

Electroacupuncture for acute gouty arthritis: a systematic review and meta-analysis of randomized controlled trials

Serum Urate and Its Association With Gout Flares

Towards a patient-centred definition for atopic dermatitis flare: a qualitative study of adults with atopic dermatitis

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