Abstract
BackgroundMethods of gout flare reporting in research settings are inconsistent and poorly defined. The aim of this study was to describe patterns of gout flare and assess the concurrent validity of different methods of flare reporting in a gout clinical trial.MethodsDaily flare diary entries including self-report of flare and pain scale from a randomised controlled trial of 120 patients with gout were analysed. Detailed pain-by-time plots for each participant were inspected and analysed for different methods of flare reporting for both self-report and the classification tree (CART)-defined flare developed by Gaffo in 2012. Concurrent validity for different methods of flare reporting were analysed.ResultsAlthough the single gout flare had a ‘typical’ average pattern (peak on day 1 and resolution over 14 days), individual pain-by-time plots showed wide variation in pain intensity, duration and frequency of flares. Over the four-month study period, there were 84/120 (70%) participants who experienced at least one self-reported flare that was not a ‘typical’ flare. The time to first self-reported flare correlated poorly with other measures of gout activity and other methods of flare reporting. The number of days with flare (either self-reported or Gaffo-defined) and the area under the pain-by-time curve correlated most strongly with other measures of disease severity.ConclusionThere is wide variation in the patterns of flare over time in individuals with gout, leading to challenges for flare reporting in clinical trials. Time-dependent reporting strategies such as number of days with flare or area under the pain-by-time curve correlate well with other measures of gout disease severity and may provide a more accurate measure of flare burden.Trial registrationClinical trial number: ACTRN12609000479202, registered 17/06/2009.
Highlights
Methods of gout flare reporting in research settings are inconsistent and poorly defined
After a 1 month run-in period, study participants (n = 120) were randomized to one of three treatment arms for 3 months: skim milk powder enriched with glycomacropeptide (GMP) and G600 milk fat extract (G600) (n = 40), or one of two control groups; skim milk powder alone (n = 40) or lactose control (n = 40)
This study reported a greater improvement from baseline in number of gout flares over a three-month treatment period with the skim milk powder/GMP/G600 treatment
Summary
Methods of gout flare reporting in research settings are inconsistent and poorly defined. The aim of this study was to describe patterns of gout flare and assess the concurrent validity of different methods of flare reporting in a gout clinical trial. Despite the importance of flares for patients [5], methods of flare reporting in gout research are inconsistent and poorly defined. In 2012, Gaffo et al described a preliminary definition of gout flare for use in clinical research based on this initial work; two the presence of being in the state of flare and the time characteristics of a single flare have been defined, the optimal method of reporting flares over time is unclear. The aim of this study was to describe patterns of gout flare and assess the concurrent validity of different methods of flare reporting
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