To develop the consensus statement, three rounds of Delphi exercises were conducted via email with 76 G-CAN members from Europe, North America, the Asia-Pacific region and Latin America to ascertain which disease states were meaningful to participants and how to define them. A subsequent face-to-face meeting of 35 of the respondents was convened Oct. 20, 2018, in Chicago to reach agreement on eight recommended disease state labels:
- Asymptomatic hyperuricemia, in the absence of gout;
- Asymptomatic MSU crystal deposition, which may be demonstrated by imaging or microscopic analysis;
- Asymptomatic hyperuricemia with MSU crystal deposition;
- Gout;
- Tophaceous gout, with at least one subcutaneous tophus;
- Erosive gout, with at least one gouty bone erosion;
- First gout flare; and
- Recurrent gout flares.
Basic Elements of Gout
G-CAN previously published a consensus statement on the disease elements of gout—11 basic elements of disease pathophysiology and clinical features—published in Arthritis Care & Research.2 The group used this framework to establish the new consensus on gout disease states.
The recommendations build on the previously endorsed nomenclature for disease elements and propose that the label gout be applied to current or prior clinically evident disease caused by MSU crystal deposition. In other words, gout is not just the underlying pathophysiologic process of MSU crystal deposition, but the presence of clinical sequelae of that deposition. “We think the term gout should be reserved for clinically evident disease,” Dr. Bursill explains.
“I am hoping that researchers and care providers make a conscious attempt to use this standardized nomenclature,” he says. “I use it in my own clinical practice and I have found that patients quickly mirror the terms used in our consultations. Considerable thought has gone into producing terms that are not only consistent and concise, but also convey important information about the causes and presentation of gout.”
This emphasis on gout as a clinical condition, not just the presence of MSU crystals, is consistent with existing clinical guidelines that gout should not be treated unless it has clinical manifestations, Dr. Bursill says.
Larry Beresford is a medical journalist in Oakland, Calif.
References
- Bursill D, Taylor WJ, Terkeltaub R, et al. Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) consensus statement regarding labels and definitions of disease states of gout. Ann Rheum Dis. 2019 Nov;78(11):1592–1600.
- Bursill D, Taylor WJ, Terkeltaub R, et al. Gout, Hyperuricemia, and Crystal-Associated Disease Network consensus statement regarding labels and definitions for disease elements in gout. Arthritis Care Res (Hoboken). 2019 Mar;71(3):427–434.
