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Crystal arthropathies
Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) consensus statement regarding labels and definitions of disease states of gout
  1. David Bursill1,
  2. William J Taylor2,3,
  3. Robert Terkeltaub4,
  4. Abhishek Abhishek5,
  5. Alexander K So6,
  6. Ana Beatriz Vargas-Santos7,
  7. Angelo Lino Gaffo8,
  8. Ann Rosenthal9,10,
  9. Anne-Kathrin Tausche11,
  10. Anthony Reginato12,
  11. Bernhard Manger13,
  12. Carlo Sciré14,15,
  13. Carlos Pineda16,
  14. Caroline van Durme17,
  15. Ching-Tsai Lin18,
  16. Congcong Yin19,
  17. Daniel Arthur Albert20,
  18. Edyta Biernat-Kaluza21,
  19. Edward Roddy22,
  20. Eliseo Pascual23,24,
  21. Fabio Becce25,
  22. Fernando Perez-Ruiz26,27,28,
  23. Francisca Sivera29,
  24. Frédéric Lioté30,31,
  25. Georg Schett32,
  26. George Nuki33,
  27. Georgios Filippou34,
  28. Geraldine McCarthy35,36,
  29. Geraldo da Rocha Castelar Pinheiro37,
  30. Hang-Korng Ea38,
  31. Helena De Almeida Tupinambá39,
  32. Hisashi Yamanaka40,41,
  33. Hyon K Choi42,
  34. James Mackay43,
  35. James R ODell44,
  36. Janitzia Vázquez Mellado45,
  37. Jasvinder A Singh46,47,48,
  38. John D Fitzgerald49,
  39. Lennart T H Jacobsson50,
  40. Leo Joosten51,
  41. Leslie R Harrold52,53,
  42. Lisa Stamp54,
  43. Mariano Andrés55,56,
  44. Marwin Gutierrez57,
  45. Masanari Kuwabara58,59,
  46. Mats Dehlin60,
  47. Matthijs Janssen61,
  48. Michael Doherty5,
  49. Michael S Hershfield62,
  50. Michael Pillinger63,
  51. N Lawrence Edwards64,
  52. Naomi Schlesinger65,
  53. Nitin Kumar66,
  54. Ole Slot67,
  55. Sebastien Ottaviani68,
  56. Pascal Richette69,
  57. Paul A MacMullan70,
  58. Peter T Chapman71,
  59. Peter E Lipsky72,
  60. Philip Robinson73,
  61. Puja P Khanna74,
  62. Rada N Gancheva75,
  63. Rebecca Grainger76,77,
  64. Richard J Johnson78,
  65. Ritch Te Kampe17,
  66. Robert T Keenan79,
  67. Sara K Tedeschi80,81,
  68. Seoyoung Kim82,
  69. Sung Jae Choi83,
  70. Theodore R Fields84,
  71. Thomas Bardin85,
  72. Till Uhlig86,
  73. Tim Jansen87,
  74. Tony Merriman88,
  75. Tristan Pascart89,
  76. Tuhina Neogi90,
  77. Viola Klück91,
  78. Worawit Louthrenoo92,
  79. Nicola Dalbeth93
  1. 1 Department of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
  2. 2 Department of Medicine, University of Otago, Wellington, New Zealand
  3. 3 Wellington Regional Rheumatology Unit, Hutt Valley District Health Board, Lower Hutt, New Zealand
  4. 4 Department of Rheumatology, UCSD/ VA Medical Center, San Diego, California, USA
  5. 5 Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
  6. 6 Department of Musculoskeletal Medicine, Service de RMR, Lausanne, Switzerland
  7. 7 Department of Internal Medicine, Rheumatology Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
  8. 8 Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
  9. 9 Division of Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  10. 10 Translational Research Unit, Clement J Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
  11. 11 Department of Rheumatology, University Hospital 'Carl Gustav Carus' of the Technical University Dresden, Dresden, Germany
  12. 12 Division of Rheumatology, The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
  13. 13 Rheumatology and Immunology, Universität Erlangen-Nürnberg, Erlangen, Germany
  14. 14 Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
  15. 15 Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
  16. 16 Department of Rheumatology, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
  17. 17 Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
  18. 18 Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
  19. 19 Department of Immunology and Dermatology, Henry Ford Health System, Detroit, Michigan, USA
  20. 20 Department of Rheumatology, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire, USA
  21. 21 Outpatient Rheumatology Clinic, Nutritional and Lifestyle Medicine Centre, ORLIK, Warsaw, Poland
  22. 22 Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
  23. 23 Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
  24. 24 Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
  25. 25 Department of Diagnostic and Interventional Radiology, University of Lausanne, Lausanne, Switzerland
  26. 26 Rheumatology Division, Cruces University Hospital, Baracaldo, Spain
  27. 27 Department of Medicine, University of the Basque Country, Biscay, Spain
  28. 28 Investigation Group for Arthritis, Biocruces Health Research Institute, Baracaldo, Spain
  29. 29 Department of Rheumatology, Hospital General Universitario Elda, Elda, Spain
  30. 30 Department of Rhumatologie, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, Paris, France
  31. 31 Department of Rhumatologie, INSERM UMR-1132 and Université Paris Diderot, Paris, France
  32. 32 Department of Internal Medicine III, Friedrich-Alexander University Erlangen-Nürnberg and Universitatsklinikum Erlangen, Erlangen, Germany
  33. 33 Insititute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
  34. 34 Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
  35. 35 Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
  36. 36 School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
  37. 37 Department of Internal Medicine, Rheumatology Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
  38. 38 Department of Rheumatology, Hôpital Lariboisière, Paris, France
  39. 39 Rheumatology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
  40. 40 Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
  41. 41 School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan
  42. 42 Section of Rheumatology and Clinical Epidemiology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
  43. 43 President and CEO, Aristea Therapeutics, San Diego, California, USA
  44. 44 Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
  45. 45 Department of Rheumatology, Hospital General de Mexico and Universidad Nacional Autónoma de México, Mexico City, Mexico
  46. 46 Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
  47. 47 Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
  48. 48 Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
  49. 49 Department of Medicine/Rheumatology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
  50. 50 Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  51. 51 Department of Internal Medicine, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
  52. 52 Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  53. 53 Chief Scientific Officer, Corrona, LLC, Southborough, Massachusetts, USA
  54. 54 Department of Medicine, Otago University, Christchurch, New Zealand
  55. 55 Department of Rheumatology, Hospital Universitario de Alicante, Alicante, Spain
  56. 56 Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
  57. 57 Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional Rehabilitación, México City, México
  58. 58 Division of Renal Diseases and Hypertension, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
  59. 59 Department of Cardiology, Toranomon Hospital, Minato-ku, Japan
  60. 60 Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Göteborg, Göteborg, Sweden
  61. 61 Department of Rheumatology, VieCuri Medical Centre, Venlo, The Netherlands
  62. 62 Division of Rheumatology, Duke University Medical Center, Durham, North Carolina, USA
  63. 63 Department of Rheumatology/Medicine, New York University School of Medicine, New York City, New York, USA
  64. 64 College of Medicine, University of Florida, Gainesville, Florida, USA
  65. 65 Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
  66. 66 Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Detroit, Michigan, USA
  67. 67 Department of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spinal Disorders, Rigshospitalet Glostrup, Glostrup, Denmark
  68. 68 Department of Rheumatology, Bichat-Claude Bernard Hospital, University of Sorbonne Paris Cité, Paris, France
  69. 69 Service de Rhumatologie, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université de Paris, Paris, France
  70. 70 Division of Rheumatology, University of Calgary, Calgary, Alberta, Canada
  71. 71 Department of Rheumatology, Immunology and Allergy, Canterbury District Health Board, Christchurch, New Zealand
  72. 72 CEO and CMO, AMPEL BioSolutions, LLC, Charlottesville, Virginia, USA
  73. 73 School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  74. 74 Department of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
  75. 75 Clinic of Rheumatology, University Hospital ‘St. Ivan Rilski’, Sofia, Bulgaria
  76. 76 Department of Medicine, University of Otago, Wellington, Wellington, New Zealand
  77. 77 Wellington Regional Rheumatology Unit, Hutt Valley District Health Board, Lower Hutt, New Zealand
  78. 78 Division of Renal Diseases and Hypertension, University of Colorado Denver, Denver, Colorado, USA
  79. 79 Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
  80. 80 Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
  81. 81 Arthritis Center, Harvard Medical School, Boston, Massachusetts, USA
  82. 82 Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  83. 83 Division of Rheumatology, Department of Internal Medicine, Korea University Medical College, Ansan, South Korea
  84. 84 Weill Cornell Medical College, Hospital for Special Surgery, New York City, New York, USA
  85. 85 Department of Rheumatology, Hôpital Lariboisière, Assistance Publique-Hopitaux de Paris, and INSERM UMR-1132 and Université de Paris, Paris, France
  86. 86 Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  87. 87 Department of Rheumatology, VieCuri Medical Centre, Venlo, The Netherlands
  88. 88 Department of Biochemistry, University of Otago, Dunedin, New Zealand
  89. 89 Department of Rheumatology, Lille Catholic University, Saint-Philibert Hospital, Lomme, France
  90. 90 Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  91. 91 Department of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
  92. 92 Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  93. 93 Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  1. Correspondence to Dr David Bursill, Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia; davebursill{at}bigpond.com

Abstract

Objective There is a lack of standardisation in the terminology used to describe gout. The aim of this project was to develop a consensus statement describing the recommended nomenclature for disease states of gout.

Methods A content analysis of gout-related articles from rheumatology and general internal medicine journals published over a 5-year period identified potential disease states and the labels commonly assigned to them. Based on these findings, experts in gout were invited to participate in a Delphi exercise and face-to-face consensus meeting to reach agreement on disease state labels and definitions.

Results The content analysis identified 13 unique disease states and a total of 63 unique labels. The Delphi exercise (n=76 respondents) and face-to-face meeting (n=35 attendees) established consensus agreement for eight disease state labels and definitions. The agreed labels were as follows: ‘asymptomatic hyperuricaemia’, ‘asymptomatic monosodium urate crystal deposition’, ‘asymptomatic hyperuricaemia with monosodium urate crystal deposition’, ‘gout’, ‘tophaceous gout’, ‘erosive gout’, ‘first gout flare’ and ‘recurrent gout flares’. There was consensus agreement that the label ‘gout’ should be restricted to current or prior clinically evident disease caused by monosodium urate crystal deposition (gout flare, chronic gouty arthritis or subcutaneous tophus).

Conclusion Consensus agreement has been established for the labels and definitions of eight gout disease states, including ‘gout’ itself. The Gout, Hyperuricaemia and Crystal-Associated Disease Network recommends the use of these labels when describing disease states of gout in research and clinical practice.

  • gout
  • urate
  • hyperuricemia
  • monosodium urate crystals
  • nomenclature
  • language
  • terminology

https://doi.org/10.1136/annrheumdis-2019-215933

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors ND (the guarantor) accepts full responsibility for the work and the conduct of the project, had access to the data and controlled the decision to publish. ND, DB, WJT and RT conceived of the project. DB and ND were responsible for devising the Delphi exercise surveys and the running of the face-to-face meeting, including the analysis of results. All authors participated in either or both of the Delphi exercise and face-to-face consensus meeting. DB and ND drafted the first version of the manuscript. All authors contributed to manuscript revisions and approved the final manuscript.

    • Funding Work by DB was supported by an Australian Rheumatology Association/Arthritis South Australia Post-Graduate Rheumatology grant.RT reports research grants from the VA Research Service (I01 BX001660-06), NIH (AR060772).

    • Competing interests AKT has received speaking fees and honoraria for advisory boards from Berlin Chemie Menarini, Novartis, Grünenthal and AstraZeneca. JAS has received consultant fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health and the American College of Rheumatology. JAS owns stock options in Amarin pharmaceuticals and Viking therapeutics. JAS is a member of the executive of OMERACT, an organisation that develops outcome measures in rheumatology and receives arms-length funding from 36 companies. JAS is a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. JAS previously served as a member of the following committees: member, the American College of Rheumatology's (ACR) Annual Meeting Planning Committee (AMPC) and Quality of Care Committees, the Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee and the co-chair of the ACR Criteria and Response Criteria subcommittee. ND has received speaking fees from Pfizer, Horizon, Janssen, and AbbVie, consulting fees from Horizon, AstraZeneca, Dyve Biosciences, Hengrui, and Kowa, and research funding from Amgen and AstraZeneca.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.