Patient_Reported_Outcome_Measures_in_Rheumatic_Diseases

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in pain reduction between the two groups was 0.5 mm per day for pain at rest and
1.2 mm for pain with activity, statistically signifi cant during the follow phase (rest:
p = 0.04; activity: p = 0.026) [ 48 ]. Thus, VAS pain has discriminant ability to distin-
guish between two effective therapies for acute gout.
A prospective study evaluated 19 patients with acute gout randomized into two
groups, oral prednisolone with colchicine and oral prednisolone with colchicine and
topical ice. Mean VAS pain (0–100 mm) reduction with oral prednisolone and col-
chicine treatment was 48.6 mm after 1 week (pretreatment: 96.0 mm; posttreatment:
47.4 mm); topical ice led to an additional reduction of 29 mm in pain VAS com-
pared to control group (pretreatment: 85.5 mm; posttreatment: 8.0 mm). At 1 week,
the VAS pain was signifi cantly lower in the ice treatment group compared with the
control ( p = 0.021) [ 49 ].
Two RCTs compared subcutaneous canakinumab 150 mg with intramuscular
triamcinolone acetonide 40 mg in patients with acute gouty arthritis ( n = 443). Mean
patient age was 53 years. The mean difference in VAS pain between canakinumab
and triamcinolone acetonide groups posttreatment was 10.7 mm at 72 h (35.7 mm
vs. 25.0 mm), with statistically signifi cantly greater reduction in VAS pain with
canakinumab than triamcinolone acetonide ( p < 0.0001). The mean difference was
statistically signifi cantly lower for canakinumab compared to triamcinolone aceton-
ide at 24 h (mean difference: −10.2 (42.6 mm vs. 52.8 mm; p = 0.001) [ 50 ].
Pre- and posttreatment studies of Pain VAS in acute gout (Table 9.3 ): 19 patients
with acute gout received a single dose of intra-articular triamcinolone acetonide,
which resulted in reduction in pain VAS from 88 mm (range: 82–93) at baseline to
0 mm (range: 0–21) at 48 h [ 54 ]. In a multicenter retrospective study of 40 patients
who received subcutaneous anakinra for gouty arthritis , VAS pain score statistically
signifi cantly decreased from 73.5 mm (range: 70–80) at baseline to 25.0 mm (range:
20–32.5) at 4 days ( p < 0.0001) [ 51 ]. Nine patients with acute gouty arthritis were
treated with intramuscular ketorolac injection. VAS pain decreased by 54.2 mm
from 64.3 to 10.1 mm at 90 min, a statistically signifi cant ( p < 0.01) [ 52 ].

Table 9.4 Visual analog scale scores in studies of chronic gout

Study/drug comparison Outcome

VAS scores, placebo

group/phase

VAS scores,

intervention group/

phase

Pegloticase biweekly vs.

placebo [ 9 ]

Pain at 25 weeks MCID for pain a

achieved: 27 %

MCID for pain a

achieved: 55 %

N = 212

Rilonacept vs. placebo

cross-over study [ 53 ]

Pain reduction at

8 weeks

Median reduction:

50 mm

Median reduction:
13 mm b
N = 10
VAS Visual Analog Scale, MCID Minimal Clinically Important Difference
a MCID pain was defi ned as ≥10 points on a 100 mm VAS
b One withdrawal due to serious injection site erythema and induration

J. Singh and N. Shah