Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: There is currently no agreed criterion for remission in chronic gout. The aim of this study was to develop a preliminary definition for remission in chronic gout.
Methods: Eighty unique paper patient profiles were generated by creating plausible baseline and 12-month values of measures for each core domain recommended by OMERACT for chronic gout trials. Rheumatologists interested in gout were invited by email to evaluate each profile within an online survey and to decide whether the 12-month values indicated that the paper patient had attained a state of remission or not and the confidence in that decision (scale of 0 to 10). The exercise also asked respondents to consider whether the change in measures from baseline to 12-months represented a response to treatment or not, but those results have been reported separately. The distribution of the confidence ratings (-10 meaning high confidence of not in remission to +10 meaning high confidence of being in remission) for each patient profile were examined by a panel of 5 very experienced rheumatologists, who made a judgement that the distribution of confidence ratings indicated remission, not remission or uncertainty. An agreement of at least 80% was required amongst the 5 experts, to classify the remission status of the profile otherwise it was classified as ‘uncertain’.
Results: There were 35 respondents. The median number of respondents per rated profile was 22.5 (range 22 to 33). This represents a median of 64% profiles that were rated by every respondent (range 63% to 94%). Two respondents did not rate any profiles and 63% (n=22) rated all 80 profiles. Of the 80 paper profiles, there was agreement by the panel of 5 experts that only 3 were in remission, 18 were uncertain and 59 were not in remission.
The mean, minimal value and maximal value for each measure, by remission status are shown in the Table. The p-value refers to ANOVA, comparing values across the 3 groups.
Conclusion: The domains that showed the greatest discrimination between remission and non-remission were SUA, tophi and flares. Pain between flares did not appear to discriminate between remission and non-remission status. The following definition of remission is proposed, based approximately on the maximal values observed in those who attained remission:
SUA no more than 0.36 mmol/l AND no gout attacks in prior 3 months AND no tophi AND patient global assessment no more than 3 (0 to 10 scale).
Table: Mean (range) of core domain measures for different categories of remission status
|
Judgement of remission status
|
p-value
|
|||
|
Not remission (n=59)
|
Remission (n=3)
|
Uncertain (n=18)
|
||
|
SUA (mmol/L)
|
0.45 (0.20 to 0.80) |
0.23 (0.20 to 0.30) |
0.31 (0.20 to 0.40) |
<0.001 |
|
Attack frequency (over previous 3 months)
|
3.53 (0 to 7.00) |
0 (0 to 0) |
1.06 (0 to 4.00) |
<0.001 |
|
Tophus size (mm2)
|
823.94 (0 to 1800) |
0 (0 to 0) |
380.56 (0 to 1350) |
<0.001 |
|
Tophus number
|
2.75 (0 to 6) |
0 (0 to 0) |
1.50 (0 to 7) |
0.004 |
|
Mental health component of SF-36 |
70.73 (50 to 86) |
78.67 (72 to 85) |
76.78 (66 to 93) |
0.021 |
|
Physical health component of SF-36
|
74.46 (50 to 91) |
84.67 (80 to 88) |
80.44 (58 to 90) |
0.025 |
|
Pain VAS (0 to 100) |
27.17 (14 to 83) |
20.00 (16 to 26) |
21.89 (10 to 35) |
0.267 |
|
HAQ-DI
|
0.87 (0 to 2.20) |
0 (0 to 0) |
0.53 (0 to 2.10) |
0.001 |
|
Patient Global VAS (0 to 100) |
53.02 (26 to 85) |
33.00 (28 to 36) |
41.22 (26 to 62) |
0.001 |
Disclosure:
W. Taylor,
None;
N. Dalbeth,
None;
J. A. Singh,
research and travel grants from Takeda, Savient, Wyeth and Amgen,
2,
speaker honoraria from Abbott,
,
Consultant fees from URL pharmaceuticals, Savient, Takeda, Ardea, Allergan and Novartis.,
5;
K. G. Saag,
Amgen,
2,
Eli Lilly and Company,
2,
Merck Pharmaceuticals,
2,
Novartis Pharmaceutical Corporation,
2,
Amgen,
5,
Eli Lilly and Company,
5,
Merck Pharmaceuticals,
5,
Novartis Pharmaceutical Corporation,
5;
H. R. Schumacher,
None.
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