GOUT

Working group OMERACT > GOUT

MENTOR:

L TERSLEV  and MA D'Agostino  

Convenors: L Terslev, M Gutierrez

Website responsible: S Christiansen

Target domain:

Chronic gout; tophus burden (inner circle), joint

damage (middle circle) and joint inflammation (middle circle).  

Objective of the subgroups work: 

1.      To develop US elementary gout lesions and to develop a semiquantitative scoring system for US elementary gout lesions

2.      Investigation of reliability, and when reliable

3.      Truth, Discrimination and Feasibility

4.      After obtaining step 1-3, try endorsement of instrument

Description of possible contribution of the subgroup work for OMERACT :

The OMERACT US gout group can contribute to the overall OMERACT work since the US modality can potentially act as an outcome measurement tool in chronic gout for measuring of both tophus burden (inner circle), joint damage (middle circle) and joint inflammation (middle circle).

Short description of the previous work (including publications)

The OMERACT US gout working group have (based on existing terms obtained from a systematic literature review, step 1 in the validation process) developed consensus-based definitions of US gout elementary lesions (step 2 in the validation process). These definitions are validated in static images and in patients (step 3 in the validation process). Evidence for the elementary lesions has been established and so has sensitivity to change of the lesions (step 4 in the validation process).

Most recently, a consensus-based and reliable re-definition of the US lesion “aggregates” has been obtained, as they performed poorly in the first reliability exercises. Furthermore, a consensus-based semi-quantitative scoring system of US gout lesions has been developed (step 2 in the validation process) and the scoring system has been tested in a static image reading exercise, where the inter- and intra-reader reliability of the scoring system was found good for all lesions (step 3 in the validation process).

Publications

·         Systematic literature review: Chowalloor P, Keen H. A systematic review of ultrasonography in gout and asymptomatic hyperuricaemia. Ann Rheum Dis 72: 638–645.

·         Defining consensus-based definition of elementary lesions: Gutierrez et al. International Consensus for ultrasound lesions in gout. Rheumatology 2015;54:1797-805.

·         Testing inter- and intra-observer reliability in static images: Gutierrez et al. International Consensus for ultrasound lesions in gout. Rheumatology 2015;54:1797-805.

·         Testing inter- and intra-observer reliability in patients: Terslev et al. Assessing Elementary Lesions in Gout by Ultrasound. J Rheumatol 2015;42:2149-54.

·         Sensitivity to change: Christiansen SN et al. Assessing the sensitivity to change of the OMERACT ultrasound structural gout lesions during urate-lowering therapy. RMD Open. 2020 Jan;6(1):e001144 AND Hammer HB et al. Ultrasound shows rapid reduction of crystal depositions during a treat-to-target approach in gout patients: 12-month results from the NOR-Gout study. Ann Rheum Dis. 2020 Nov;79(11):1500-1505.

·        Re-definition of the aggregates and development of the semi-quantitative scoring system for gout lesions: Christiansen SN et al. Consensus-based semi-quantitative ultrasound scoring system for gout lesions: Results of an OMERACT Delphi process and web-reliability exercise. Semin Arthritis Rheum. 2021 Jun;51(3):644-649.

Reporting back of work done since previous F2F meeting (ACR, EULAR or OMERACT)

Ongoing research is investigating validity aspects of the elementary gout lesions (step 4) in form of construct validity (US vs. DECT).

Next steps and discussion points

The semi-quantitative scoring system for US elementary gout lesions have to be validated in a patient-based exercise.