Gout definitions less than crystal clear

Gout was recognised millennia ago, but rheumatologists still can’t agree on definitions for the key elements of the disease.

In a poster presented at the ACR meeting here in San Diego, Australian and New Zealand rheumatologists found that published papers agreed strongly on some terms including ‘hyperuricaemia’ and ‘tophus’, but had trouble achieving harmony in terms as basic as ‘acute gout’ and ‘erosion’.

“The existing nomenclature of gout disease elements is imprecise and inconsistent,” they concluded.

The imprecision could be a barrier to effective communication in both clinical and research settings and required consensus to resolve the inconsistencies, they said.

Dr David Bursill, from Adelaide, and colleagues analysed 549 articles on gout or hyperuricaemia published in the top 10 rheumatology journals and top five general medicine journals between 2012 and 2017.

They identified 342 different labels used to describe 10 basic elements of the disease.

‘Hyperuricaemia’ was used by 99% of articles to describe ‘an elevated circulating level of the final enzymatic product generated by xanthine oxidase in purine metabolism in humans’.

‘Tophus’ also caused little difficulty, used in 92.5% of articles to describe ‘a discrete collection of pathogenic crystals with associated host-response tissue’.

A remarkable total of 162 different labels were used to describe ‘an episode of acute inflammation triggered by the presence of pathogenic crystals’. ‘Acute gout’ was most popular, but was used in only 34% of cases. About one-third of articles used at least four different labels in the same paper.

Similarly, authors managed to generate 30 different labels for ‘the presence of structural bone damage due to gout’. Only 54% used the most common term, ‘erosion’.

The survey did not settle the continuing battle between ‘uric acid’ and ‘urate’. Each was used in about 63% of articles, and both labels were used interchangeably in 26% articles.

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