Measurement of outcome in gout

An explosion of new agents for chronic and acute gout has highlighted problems with standardized and relevant outcomes for clinical trials and observational studies. Some progress has been made through the OMERACT process, identifying important domains for chronic and acute gout settings and instruments for measuring many of those domains. However, important deficiencies remain. In particular, patient involvement has been relatively limited and probably suggests that not all concerns of patients are captured through the existing OMERACT domains. It is suggested that the framework of the International Classification of Functioning, Health and Disability be used to guide further work in this area. There are early indications of a valid composite measure of disease activity that might be useful in defining disease states such as remission, low disease activity or patient acceptable state. More work needs to be done on how to best use flares as indicators of outcome in chronic gout and how to measure disability during gout flares. Finally, a way to show that serum urate is a good surrogate for relevant and patient-centred outcomes needs to be identified. It seems obvious in clinical practice but is yet to be clearly demonstrated.