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

Academic Article


  • 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.
  • Published In


  • Adult, Aged, Cluster Analysis, Cognition, Consensus, Data Collection, Delphi Technique, Female, Gout, Humans, Inflammation, Male, Middle Aged, Pain, Severity of Illness Index
  • Digital Object Identifier (doi)

    Author List

  • Taylor WJ; Shewchuk R; Saag KG; Schumacher HR; Singh JA; Grainger R; Edwards NL; Bardin T; Waltrip RW; Simon LS
  • Start Page

  • 535
  • End Page

  • 543
  • Volume

  • 61
  • Issue

  • 4