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-RuizLorenzo Cavagna, Geraldine M. McCarthy, Lisa K. Stamp, Martijin Gerritsen, Viktoria Fana, Francisca Sivera, Angelo L. Gaffo

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)293-298
Number of pages6
JournalJournal of Rheumatology
Issue number2
Publication statusPublished - Feb 1 2021


  • Disease activity
  • Gout
  • Remission

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology


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