Simplified Gout Remission Definition Feasible, Valid

A simplified gout remission definition was a feasible and valid option when compared with the 2016 preliminary gout remission definition when compared in a study of nurse-led and usual (general practitioner) care.¹

“To date, discrimination of the remission definitions between intervention groups has not been demonstrated in a clinical trial of urate-lowering therapy. Therefore, we compared the performance of the 2016 preliminary gout remission definition and the simplified gout remission definition by evaluating their discrimination between intervention groups, sensitivity to change over time, and construct validity, in a community-based clinical trial of nurse-led treat-to-target gout care versus usual general practitioner care,” lead investigator Adwoa Dansoa Tabi-Amponsah, PhD candidate, Department of Medicine, The Faculty of Medical and Health Sciences, University of Auckland, New Zealand, and colleagues wrote.¹

Tabi-Amponsah and colleagues analyzed data from a 2-year, parallel arm, randomized, unblinded trial involving 517 community derived participants with gout who were randomized 1:1 to receive nurse-led care or general practitioner usual care. Remission definitions were compared between the 2016 preliminary gout remission definition and a simplified gout remission definition without patient reported outcomes by binary logistic regression. They also compared Gout Impact Scale (GIS) scores with general linear models between those in remission and those not in remission using either definition.

The investigators found that participants in the nurse-led care group were more likely to achieve remission using either definition with an odds ratio (OR) at year 2 of 7.92 [95% CI, 4.86–12.92] using the 2016 preliminary definition and 11.88 [95% CI, 7.49–18.84] using the simplified definition.¹

Overall, 9.9% of participants achieved remission defined by the 2016 preliminary definition at Year 1 and 28.4% achieved it at Year 2 (P <.001). More participants achieved remission according to the simplified definition (17.6% at Year 1 and 42.7% at Year 2; P <.001). Participants that achieved remission according to either definition had better gout outcomes via the GIS, including greater control over their gout, worry about future gout attacks, gout disease progression and its interference in future activities, and efficacy of gout medication, than those who did not.¹

“In summary, both remission definitions performed well in discriminating between the nurse-led care group and usual care group. The simplified definition identified more people as being in remission at Year 1 and Year 2, and also showed high construct validity using a gout specific health related quality of life instrument. The simplified definition is a feasible, sensitive, and valid option for defining gout remission,” Tabi-Amponsah and colleagues concluded.¹

Other recent research into gout flares and remission found that, unsurprisingly, overall urate lowering therapy nonadherence was linked to more flares and less urate target achievement in people with gout. Overall, adherence as assessed by Medication Adherence Report Scale (MARS-5) questionnaire was high (median, 24; interquartile range, 22-25). Patients in the lowest MARS-5 quartile had, compared to the highest quartile,flares more often during the last year of follow-up (33.3% vs. 9.5%, P =.004), and reached the 5-year serum urate treatment target less frequently (45.2% vs. 87.5%, P <.001).²

REFERENCES

1. Tabi-Amponsah AD, Doherty M, Sarmanova A, et al. Post-hoc analysis of two gout remission definitions in a two-year randomized controlled trial of nurse-led versus usual gout care. Semin Arthritis Rheum. 2024(16):152555. doi: 10.1016/j.semarthrit.2024.152555

2. Uhlig T, Karoliussen LF, Sexton J, et al.Non-adherence to urate lowering therapy in gout after 5 years is related to poor outcomes—results from the NOR-Gout study. Rheumatol. Published online September 18,2024;keae514. Doi: 10.1093/rheumatology/keae514