Results of the Delphi exercise for agreement about whether the proposed gout disease states are meaningful*
| Disease states represented by disease element clusters | Delphi exercise | ||
| Consensus achieved† (round) | Agreement (%) | ||
| Pre-clinical states | Hyperuricaemia‡ without clinical disease elements§ of gout | Yes (1) | 84% |
| Imaging evidence of MSU¶ crystal deposition without clinical disease elements§ of gout | Yes (1) | 89% | |
| Hyperuricaemia† with imaging evidence of MSU¶ crystal deposition without clinical disease elements§ of gout | Yes (1) | 86% | |
| Clinical states | Presence of MSU¶ crystals with clinical disease elements§ of gout | Yes (1) | 97% |
| Presence of MSU¶ crystals with any of the following: frequent recurrent gout flares, chronic gouty arthritis, subcutaneous tophi or imaging disease elements** of gout | Yes (1) | 93% | |
| Presence of MSU¶ crystals with subcutaneous tophi | Yes (1) | 89% | |
| Chronic gouty arthritis with at least one subcutaneous tophus | No | 74% after round 3 | |
| Presence of MSU¶ crystals with any of the following: gout flare, chronic gouty arthritis; without subcutaneous tophi | No | 74% after round 3 | |
| Presence of MSU¶ crystals with clinical disease elements§ of gout and with at least one gouty bone erosion | Yes (1) | 85% | |
| Disease course states | The first episode of gout flare without preceding intercritical gout | Yes (1) | 92% |
| More than one episode of gout flare with intercritical gout | Yes (1) | 88% | |
| Presence of MSU¶ crystals with clinical disease elements§ of gout and early in the course of disease natural history | No | 67% after round 3 | |
| Presence of MSU crystals with clinical disease elements§ of gout and late in the course of disease natural history | No | 69% after round 3 | |
*‘Meaningful’ defined as ‘having important implications for disease management and/or prognosis’.
†Consensus defined as ≥80% agreement on preferred label.
‡In British English, hyperuricaemia.
§Clinical disease elements: gout flare, intercritical gout, chronic gouty arthritis, subcutaneous tophus.
¶Imaging disease elements: imaging evidence of MSU crystal deposition, gouty bone erosion.
MSU, monosodium urate.