Toward a valid definition of gout flare: results of consensus exercises using Delphi methodology and cognitive mapping

Arthritis Rheum. 2009 Apr 15;61(4):535-43. doi: 10.1002/art.24166.


Objective: To identify, in people known to have gout, the testable, key components of a standard definition of gout flare for use in clinical research.

Methods: Consensus methodology was used to identify key elements of a gout flare. Two Delphi exercises were conducted among different groups of rheumatologists. A cognitive mapping technique among 9 gout experts with hierarchical cluster analysis provided a framework to guide the panel discussion, which identified the final set of items that should be tested empirically.

Results: From the Delphi exercises, 21 items were presented to the expert panel. Cluster analysis and multidimensional scaling showed that these items clustered into 5 concepts (joint inflammation, severity of symptoms, stereotypical nature, pain, and gout archetype) distributed along 2 dimensions (objective to subjective features and general features to specific features of gout). Using this analysis, expert panel discussion generated a short list of potential features: joint swelling, joint tenderness, joint warmth, severity of pain, patient global assessment, time to maximum pain, time to complete resolution of pain, an acute-phase marker, and functional impact of the episode.

Conclusion: A short list of features has been identified and now requires validation against a patient- and physician-defined gout flare in order to determine the best combination of features.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cluster Analysis
  • Cognition / physiology*
  • Consensus*
  • Data Collection
  • Delphi Technique*
  • Female
  • Gout / diagnosis
  • Gout / physiopathology*
  • Gout / psychology*
  • Humans
  • Inflammation / physiopathology
  • Inflammation / psychology
  • Male
  • Middle Aged
  • Pain / physiopathology
  • Pain / psychology
  • Severity of Illness Index