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Delanghe JR, De Buyzere ML, Lameire N. The revised WHO list of essential diagnostics: Still a matter of concern. Clin Chim Acta 2020; 503:236-237. [DOI: 10.1016/j.cca.2019.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 11/29/2019] [Indexed: 11/24/2022]
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Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda J, Coyfish M, Guillo S, Jansen T, Janssens H, Lioté F, Mallen CD, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell A, So AK, Tausche AK, Uhlig T, Zavada J, Zhang W, Tubach F, Bardin T. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis 2019; 79:31-38. [DOI: 10.1136/annrheumdis-2019-215315] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/12/2022]
Abstract
Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.
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Dehlin M, Landgren AJ, Bergsten U, Jacobsson LTH. The Validity of Gout Diagnosis in Primary Care: Results from a Patient Survey. J Rheumatol 2019; 46:1531-1534. [PMID: 30936288 DOI: 10.3899/jrheum.180989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Validate primary care diagnosis of gout by the Mexico and the Netherlands classification criteria. METHODS Questionnaires on gout characteristics were sent to all individuals aged ≥ 18 with ≥ 1 International Classification of Diseases, 10th ed. diagnosis of gout at 12 primary care centers. RESULTS Positive predictive values for gout diagnosis ranged from 71% for the Netherlands criteria to 80% for the Mexico criteria. Maximum inflammation within 24 h was the most common reported symptom (86%). CONCLUSION The vast majority of gout cases in primary care fulfill classification criteria and are valid for research purposes.
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Affiliation(s)
- Mats Dehlin
- From the Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; R&D Department at Region Halland, Halmstad, Sweden. .,M. Dehlin, MD, Associate Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; A.J. Landgren, MD, PhD student, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; U. Bergsten, PhD, R&D Department at Region Halland; L.T. Jacobsson, MD, Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg.
| | - Anton J Landgren
- From the Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; R&D Department at Region Halland, Halmstad, Sweden.,M. Dehlin, MD, Associate Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; A.J. Landgren, MD, PhD student, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; U. Bergsten, PhD, R&D Department at Region Halland; L.T. Jacobsson, MD, Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg
| | - Ulrika Bergsten
- From the Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; R&D Department at Region Halland, Halmstad, Sweden.,M. Dehlin, MD, Associate Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; A.J. Landgren, MD, PhD student, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; U. Bergsten, PhD, R&D Department at Region Halland; L.T. Jacobsson, MD, Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg
| | - Lennart T H Jacobsson
- From the Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; R&D Department at Region Halland, Halmstad, Sweden.,M. Dehlin, MD, Associate Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; A.J. Landgren, MD, PhD student, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg; U. Bergsten, PhD, R&D Department at Region Halland; L.T. Jacobsson, MD, Professor, Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg
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Value of ultrasonography in the diagnosis of gout in patients presenting with acute arthritis. Skeletal Radiol 2017; 46:759-767. [PMID: 28275814 DOI: 10.1007/s00256-017-2611-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the value of ultrasonographic features of crystal deposition for diagnosing gout in patients presenting with acute arthritis. MATERIALS AND METHODS Ultrasound scanning of the most inflamed joint was performed on 89 consecutively enrolled patients with acute arthritis. Two radiologists independently reviewed the ultrasound images, and a consensus was achieved with a third radiologist when the interpretations of four key ultrasound features of gout differed. Arthrocentesis and crystal analysis using compensated polarized light microscopy of aspirates are considered the gold standards for gout diagnosis. RESULTS Fifty-three (60%) patients had gout, whereas the remaining 36 (40%) had non-gout arthritis. The mean serum uric acid level was 7.1 mg/dl in patients with gout and 4.7 mg/dl in patients with non-gout arthritis. Three US features differed significantly (p < 0.001) between patients with gout and non-gout arthritis: the double contour sign (42 vs. 8%, respectively), intra-articular aggregates (58 vs. 8%), and tophi (40 vs. 0%). No statistically significant differences in detecting intra-tendinous aggregates (32 vs. 17%, p = 0.14) were observed. The sensitivity and specificity of the double contour sign were 42 and 92%, respectively; those of the intra-articular aggregates were 58 and 92%; and those of tophi were 40 and 100%. The positive predictive values for these three features ranged from 88 to 100%, whereas the negative predictive values ranged from 52 to 60%. CONCLUSIONS When the prevalence is high, these three ultrasound features may be a useful adjunct in the diagnosis of acute gout, particularly when specialized microscopic techniques are not available.
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