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Hoss IM, Pradal LDA, Leal TSDS, Bertolini GRF, Costa RM, Ribeiro LDFC. Articular mobilization promotes improvement in functional and inflammatory parameters in a gouty arthritis model. EINSTEIN-SAO PAULO 2023; 21:eAO0465. [PMID: 37909651 PMCID: PMC10586854 DOI: 10.31744/einstein_journal/2023ao0465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/12/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Gouty arthritis is characterized by painful inflammation due to the deposition of monosodium urate crystals in joint tissues. Despite available treatments, many patients experience ineffective management and adverse effects. This study evaluated a manual therapy protocol involving passive joint mobilization at the peak of inflammation in a gouty arthritis model using functional and inflammatory parameters. METHODS Twenty male Wistar rats, 12 weeks old, were divided into two groups (n=10 each): Gouty Arthritis and Control Groups, which were further subdivided into treated and untreated groups (n=5 each). The Gouty Arthritis Group received intraarticular knee injection of 50µL of monosodium urate crystals, while the Control Group received 50µL of phosphate buffered saline. The treatment involved a 9-minutes session of grade III joint mobilization (according to Maitland). Nociception, grip strength, and edema were evaluated before induction (EV0), 7 hours after assessment (EV1), immediately after treatment (EV2), and 1 hour after treatment (EV3). The animals were euthanized, and synovial fluid was collected to analyze leukocyte migration. RESULTS The model mimicked the signs of the Gouty Arthritis Group, with a decrease in the threshold of nociception and strength and an increase in edema and leukocyte count. The mobilization protocol significantly increased the nociceptive threshold and grip strength and reduced edema; however, it did not reverse the increase in leukocyte count. CONCLUSION Our results suggest that mobilization promotes analgesia and may modulate the inflammatory process owing to reduced edema and subtle attenuation of cell migration, which contributes to strength gain.
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Affiliation(s)
- Iranilda Moha Hoss
- Universidade Estadual do Oeste do ParanáCascavelPRBrazil Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil.
| | - Lilian de Araujo Pradal
- Universidade Estadual do Oeste do ParanáCascavelPRBrazil Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil.
| | - Taciane Stein da Silva Leal
- Universidade Estadual do Oeste do ParanáCascavelPRBrazil Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil.
| | - Gladson Ricardo Flor Bertolini
- Universidade Estadual do Oeste do ParanáCascavelPRBrazil Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil.
| | - Rose Meire Costa
- Universidade Estadual do Oeste do ParanáCascavelPRBrazil Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil.
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FitzGerald JD, Mikuls TR, Neogi T, Singh JA, Robbins M, Khanna PP, Turner AS, Myslinski R, Suter LG. Development of the American College of Rheumatology Electronic Clinical Quality Measures for Gout. Arthritis Care Res (Hoboken) 2018; 70:659-671. [DOI: 10.1002/acr.23500] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 12/12/2016] [Indexed: 01/22/2023]
Affiliation(s)
| | - Ted R. Mikuls
- VA Nebraska-Western Iowa Health Care System; and University of Nebraska Medical Center; Omaha
| | - Tuhina Neogi
- Boston University School of Medicine; Boston Massachusetts
| | - Jasvinder A. Singh
- Birmingham Veterans Affairs Medical Center; and University of Alabama at Birmingham
| | - Mark Robbins
- Harvard Vanguard Medical Association; Somerville Massachusetts
| | - Puja P. Khanna
- University of Michigan; and VA Ann Arbor Healthcare System; Ann Arbor Michigan
| | | | | | - Lisa G. Suter
- Yale University, New Haven, Connecticut; and West Haven Veterans Affairs Medical Center; West Haven Connecticut
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Tatlock S, Rüdell K, Panter C, Arbuckle R, Harrold LR, Taylor WJ, Symonds T. What Outcomes are Important for Gout Patients? In-Depth Qualitative Research into the Gout Patient Experience to Determine Optimal Endpoints for Evaluating Therapeutic Interventions. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:65-79. [PMID: 27384670 PMCID: PMC5250642 DOI: 10.1007/s40271-016-0184-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and Objectives Characterized by sudden onset of severe joint pain, swelling, redness, and tenderness to touch, gout ‘flare ups’ have a substantial impact on quality of life (QoL). This research employed a patient-centered approach to explore the symptoms and impacts of gout, and assess the content validity of existing patient-reported outcomes (PROs). Methods Qualitative interviews were conducted with 30 US gout patients (non-tophaceous: n = 20, tophaceous: n = 10) and five expert rheumatologists. Each interview included both concept elicitation (CE) questioning to learn about the patient experience and cognitive debriefing to assess the content validity of three PRO instruments (HAQ-DI, GAQ, and TIQ-20). Nine of the patients provided further real-time qualitative data through a smart phone application. All qualitative data were subject to thematic analysis using Atlas.ti. Two patient advisors and three expert clinicians were engaged as advisors at key stages throughout the research. Results Interview and real-time data identified the same core symptoms and proximal impact concepts. Severe pain (typically in joints of extremities) was described as the cardinal symptom, often accompanied by swelling, redness, heat, sensitivity to touch, and stiffness. Domains of QoL impacted included physical functioning, sleep, daily activities, and work. The PRO instruments were generally well-understood by patients, but each included items with questionable relevance to at least some of the sample, dependent on the specific joints affected. Conclusions Gout patients experience severe pain in affected joints, resulting in substantial limitations in physical functioning. Both the HAQ-DI and the TIQ-20 are useful for specific research purposes in the gout population, although modifications are recommended. Electronic supplementary material The online version of this article (doi:10.1007/s40271-016-0184-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sophi Tatlock
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK.
| | - Katja Rüdell
- AstraZeneca, Da Vinci Building, Melbourn Science Park, Royston, Cambridgeshire, SG86EE, UK
| | - Charlotte Panter
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK
| | - Rob Arbuckle
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK
| | - Leslie R Harrold
- Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - William J Taylor
- Rehabilitation Teaching and Research Unit, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - Tara Symonds
- Clinical Outcomes Solutions Ltd, Shearway Road, Folkestone, CT194RH, UK
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Vargas-Santos AB, Taylor WJ, Neogi T. Gout Classification Criteria: Update and Implications. Curr Rheumatol Rep 2017; 18:46. [PMID: 27342957 DOI: 10.1007/s11926-016-0594-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Gout is the most common inflammatory arthritis, with a rising prevalence and incidence worldwide. There has been a resurgence in gout research, fueled, in part, by a number of advances in pharmacologic therapy for gout. The conduct of clinical trials and other observational research in gout requires a standardized and validated means of assembling well-defined groups of patients with gout for such research purposes. Recently, an international collaborative effort that involved a data-driven process with state-of-the art methodology supported by the American College of Rheumatology and the European League Against Rheumatism led to publication of new gout classification criteria.
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Affiliation(s)
- Ana Beatriz Vargas-Santos
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, X building, Suite 200, 650 Albany Street, Boston, MA, 02118, USA
| | - William J Taylor
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington, New Zealand
| | - Tuhina Neogi
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, X building, Suite 200, 650 Albany Street, Boston, MA, 02118, USA.
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de Lautour H, Taylor WJ, Adebajo A, Alten R, Burgos-Vargas R, Chapman P, Cimmino MA, da Rocha Castelar Pinheiro G, Day R, Harrold LR, Helliwell P, Janssen M, Kerr G, Kavanaugh A, Khanna D, Khanna PP, Lin C, Louthrenoo W, McCarthy G, Vazquez-Mellado J, Mikuls TR, Neogi T, Ogdie A, Perez-Ruiz F, Schlesinger N, Ralph Schumacher H, Scirè CA, Singh JA, Sivera F, Slot O, Stamp LK, Tausche AK, Terkeltaub R, Uhlig T, van de Laar M, White D, Yamanaka H, Zeng X, Dalbeth N. Development of Preliminary Remission Criteria for Gout Using Delphi and 1000Minds Consensus Exercises. Arthritis Care Res (Hoboken) 2017; 68:667-72. [PMID: 26414176 DOI: 10.1002/acr.22741] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/09/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To establish consensus for potential remission criteria to use in clinical trials of gout. METHODS Experts (n = 88) in gout from multiple countries were invited to participate in a web-based questionnaire study. Three rounds of Delphi consensus exercises were conducted using SurveyMonkey, followed by a discrete-choice experiment using 1000Minds software. The exercises focused on identifying domains, definitions for each domain, and the timeframe over which remission should be defined. RESULTS There were 49 respondents (56% response) to the initial survey, with subsequent response rates ranging from 57% to 90%. Consensus was reached for the inclusion of serum urate (98% agreement), flares (96%), tophi (92%), pain (83%), and patient global assessment of disease activity (93%) as measurement domains in remission criteria. Consensus was also reached for domain definitions, including serum urate (<0.36 mm), pain (<2 on a 10-point scale), and patient global assessment (<2 on a 10-point scale), all of which should be measured at least twice over a set time interval. Consensus was not achieved in the Delphi exercise for the timeframe for remission, with equal responses for 6 months (51%) and 1 year (49%). In the discrete-choice experiment, there was a preference towards 12 months as a timeframe for remission. CONCLUSION These consensus exercises have identified domains and provisional definitions for gout remission criteria. Based on the results of these exercises, preliminary remission criteria are proposed with domains of serum urate, acute flares, tophus, pain, and patient global assessment. These preliminary criteria now require testing in clinical data sets.
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Affiliation(s)
| | | | | | - Rieke Alten
- Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany
| | | | | | | | | | - Ric Day
- University of New South Wales and St Vincent's Hospital, Sydney, Australia
| | - Leslie R Harrold
- University of Massachusetts Medical School, Worcester, and Corrona, LLC, Southborough
| | - Philip Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | | | - Gail Kerr
- Veterans Affairs Medical Center, Georgetown and Howard University Hospitals, Washington, DC
| | | | | | - Puja P Khanna
- University of Michigan and Ann Arbor VA Medical Center, Ann Arbor
| | - Chingtsai Lin
- Taichung Veteran's General Hospital, Taichung, Taiwan
| | | | - Geraldine McCarthy
- Mater Misericordiae University Hospital and University College, Dublin, Ireland
| | | | - Ted R Mikuls
- Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Fernando Perez-Ruiz
- Hospital Universitario Cruces, OSI-EEC, and Biocruces Health Research Institute, Biscay, Spain
| | - Naomi Schlesinger
- Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Carlo A Scirè
- IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Jasvinder A Singh
- University of Alabama at Birmingham and the Birmingham VA Medical Center, Birmingham
| | | | - Ole Slot
- Copenhagen University Hospital Glostrup, Glostrup, Denmark
| | | | | | | | - Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Douglas White
- Waikato DHB and Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | | | - Xuejun Zeng
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Nicola Dalbeth
- University of Auckland and Auckland District Health Board, Auckland, New Zealand
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Scirè CA, Carrara G, Viroli C, Cimmino MA, Taylor WJ, Manara M, Govoni M, Salaffi F, Punzi L, Montecucco C, Matucci-Cerinic M, Minisola G. Development and First Validation of a Disease Activity Score for Gout. Arthritis Care Res (Hoboken) 2016; 68:1530-7. [PMID: 26815286 PMCID: PMC5129490 DOI: 10.1002/acr.22844] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/06/2015] [Accepted: 01/12/2016] [Indexed: 01/24/2023]
Abstract
Objective To develop a new composite disease activity score for gout and provide its first validation. Methods Disease activity has been defined as the ongoing presence of urate deposits that lead to acute arthritis and joint damage. Every measure for each Outcome Measures in Rheumatology core domain was considered. A 3‐step approach (factor analysis, linear discriminant analysis, and linear regression) was applied to derive the Gout Activity Score (GAS). Decision to change treatment or 6‐month flare count were used as the surrogate criteria of high disease activity. Baseline and 12‐month followup data of 446 patients included in the Kick‐Off of the Italian Network for Gout cohort were used. Construct‐ and criterion‐related validity were tested. External validation on an independent sample is reported. Results Factor analysis identified 5 factors: patient‐reported outcomes, joint examination, flares, tophi, and serum uric acid (sUA). Discriminant function analysis resulted in a correct classification of 79%. Linear regression analysis identified a first candidate GAS including 12‐month flare count, sUA, visual analog scale (VAS) of pain, VAS global activity assessment, swollen and tender joint counts, and a cumulative measure of tophi. Alternative scores were also developed. The developed GAS demonstrated a good correlation with functional disability (criterion validity) and discrimination between patient‐ and physician‐reported measures of active disease (construct validity). The results were reproduced in the external sample. Conclusion This study developed and validated a composite measure of disease activity in gout. Further testing is required to confirm its generalizability, responsiveness, and usefulness in assisting with clinical decisions.
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Taylor WJ, Fransen J, Jansen TL, Dalbeth N, Schumacher HR, Brown M, Louthrenoo W, Vazquez-Mellado J, Eliseev M, McCarthy G, Stamp LK, Perez-Ruiz F, Sivera F, Ea HK, Gerritsen M, Scire C, Cavagna L, Lin C, Chou YY, Tausche AK, Vargas-Santos AB, Janssen M, Chen JH, Slot O, Cimmino MA, Uhlig T, Neogi T. Study for Updated Gout Classification Criteria: Identification of Features to Classify Gout. Arthritis Care Res (Hoboken) 2016; 67:1304-1315. [PMID: 25777045 DOI: 10.1002/acr.22585] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 03/03/2015] [Accepted: 03/10/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine which clinical, laboratory, and imaging features most accurately distinguished gout from non-gout. METHODS We performed a cross-sectional study of consecutive rheumatology clinic patients with ≥1 swollen joint or subcutaneous tophus. Gout was defined by synovial fluid or tophus aspirate microscopy by certified examiners in all patients. The sample was randomly divided into a model development (two-thirds) and test sample (one-third). Univariate and multivariate association between clinical features and monosodium urate-defined gout was determined using logistic regression modeling. Shrinkage of regression weights was performed to prevent overfitting of the final model. Latent class analysis was conducted to identify patterns of joint involvement. RESULTS In total, 983 patients were included. Gout was present in 509 (52%). In the development sample (n = 653), the following features were selected for the final model: joint erythema (multivariate odds ratio [OR] 2.13), difficulty walking (multivariate OR 7.34), time to maximal pain <24 hours (multivariate OR 1.32), resolution by 2 weeks (multivariate OR 3.58), tophus (multivariate OR 7.29), first metatarsophalangeal (MTP1) joint ever involved (multivariate OR 2.30), location of currently tender joints in other foot/ankle (multivariate OR 2.28) or MTP1 joint (multivariate OR 2.82), serum urate level >6 mg/dl (0.36 mmoles/liter; multivariate OR 3.35), ultrasound double contour sign (multivariate OR 7.23), and radiograph erosion or cyst (multivariate OR 2.49). The final model performed adequately in the test set, with no evidence of misfit, high discrimination, and predictive ability. MTP1 joint involvement was the most common joint pattern (39.4%) in gout cases. CONCLUSION Ten key discriminating features have been identified for further evaluation for new gout classification criteria. Ultrasound findings and degree of uricemia add discriminating value, and will significantly contribute to more accurate classification criteria.
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Affiliation(s)
| | - Jaap Fransen
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tim L Jansen
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | | | | | | | - Maxim Eliseev
- Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Geraldine McCarthy
- University College, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lisa K Stamp
- University of Otago Christchurch, Christchurch, New Zealand
| | - Fernando Perez-Ruiz
- Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya, Spain
| | | | - Hang-Korng Ea
- University of Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, INSERM, UMR 1132, Hôpital Lariboisière, AP-HP, Paris, France
| | - Martijn Gerritsen
- Amsterdam Rheumatology Immunology Center, Westfries Gasthuis, Hoorn, The Netherlands
| | - Carlo Scire
- Italian Society for Rheumatology, Milan, Italy
| | - Lorenzo Cavagna
- University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Chingtsai Lin
- Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan
| | - Yin-Yi Chou
- Taichung Veterans' General Hospital, Taichung, Taiwan
| | | | | | | | - Jiunn-Horng Chen
- China Medical University and China Medical University Hospital, Taichung, Taiwan
| | - Ole Slot
- Copenhagen University Hospital, Glostrup, Denmark
| | | | | | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
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Foot and ankle muscle strength in people with gout: A two-arm cross-sectional study. Clin Biomech (Bristol, Avon) 2016; 32:207-11. [PMID: 26653881 DOI: 10.1016/j.clinbiomech.2015.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Foot and ankle structures are the most commonly affected in people with gout. However, the effect of gout on foot and ankle muscle strength is not well understood. The primary aim of this study was to determine whether differences exist in foot and ankle muscle strength for plantarflexion, dorsiflexion, inversion and eversion between people with gout and age- and sex-matched controls. The secondary aim was to determine whether foot and ankle muscle strength was correlated with foot pain and disability. METHODS Peak isokinetic concentric muscle torque was measured for ankle plantarflexion, dorsiflexion, eversion and inversion in 20 participants with gout and 20 matched controls at two testing velocities (30°/s and 120°/s) using a Biodex dynamometer. Foot pain and disability was measured using the Manchester Foot Pain and Disability Index (MFPDI). FINDINGS Participants with gout demonstrated reduced muscle strength at both the 30°/s and 120°/s testing velocities for plantarflexion, inversion and eversion (P<0.05). People with gout also displayed a reduced plantarflexion-to-dorsiflexion strength ratio at both 30°/s and 120°/s (P<0.05). Foot pain and disability was higher in people with gout (P<0.0001) and MFPDI scores were inversely correlated with plantarflexion and inversion muscle strength at the 30°/s testing velocity, and plantarflexion, inversion and eversion muscle strength at the 120°/s testing velocity (all P<0.05). INTERPRETATION People with gout have reduced foot and ankle muscle strength and experience greater foot pain and disability compared to controls. Foot and ankle strength reductions are strongly associated with increased foot pain and disability in people with gout.
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Stewart S, Morpeth T, Dalbeth N, Vandal AC, Carroll M, Davidtz L, Mawston G, Otter S, Rome K. Foot-related pain and disability and spatiotemporal parameters of gait during self-selected and fast walking speeds in people with gout: A two-arm cross sectional study. Gait Posture 2016; 44:18-22. [PMID: 27004627 DOI: 10.1016/j.gaitpost.2015.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/09/2015] [Accepted: 11/04/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine gait parameters in people with gout during different walking speeds while adjusting for body mass index (BMI) and foot-pain, and to determine the relationship between gait parameters and foot-pain and disability. METHOD Gait parameters were measured using the GAITRite™ walkway in 20 gout participants and 20 age- and sex-matched controls during self-selected and fast walking speeds. Foot-pain and disability was measured using the Manchester Foot Pain and Disability Index (MFPDI) which contains four domains relating to function, physical appearance, pain and work/leisure. RESULTS At the self-selected speed, gout participants demonstrated increased step time (p=0.017), and stance time (p=0.012), and reduced velocity (p=0.031) and cadence (p=0.013). At the fast speed, gout participants demonstrated increased step time (p=0.007), swing time (p=0.005) and stance time (p=0.019) and reduced velocity (p=0.036) and cadence (p=0.009). For participants with gout, step length was correlated with total MFPDI (r=-0.62, p=0.008), function (r=-0.65, p=0.005) and physical appearance (r=-0.50, p=0.041); stride length was correlated with total MFPDI (r=-0.62, p=0.008), function (r=-0.65, p=0.005) and physical appearance (r=-0.50, p=0.041); and velocity was correlated with total MFPDI (r=-0.60, p=0.011), function (r=-0.63, p=0.007) and work/leisure (r=-0.53, p=0.030). CONCLUSION Gait patterns exhibited by people with gout are different from controls during both self-selected and fast walking speeds, even after adjusting for BMI and foot-pain. Additionally, gait parameters were strongly correlated with patient-reported functional limitation, physical appearance and work/leisure difficulties, while pain did not significantly influence gait in people with gout.
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Affiliation(s)
- Sarah Stewart
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand.
| | - Trish Morpeth
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand
| | - Nicola Dalbeth
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand; Department of Rheumatology, Auckland District Health Board, P.O. Box 92189, Auckland, New Zealand
| | - Alain C Vandal
- Department of Biostatistics & Epidemiology, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand; Health Intelligence and Informatics, Ko Awatea, Counties Manukau Health, Private Bag 93311, Auckland, 1640, New Zealand
| | - Matthew Carroll
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand
| | - Lisa Davidtz
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand
| | - Grant Mawston
- Department of Physiotherapy, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
| | - Simon Otter
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand; School of Health Science, University of Brighton, 49 Darley Rd, Eastbourne, BN20 7UR, UK
| | - Keith Rome
- Department of Podiatry, School of Clinical Sciences, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand Zealand
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Neogi T, Jansen TLTA, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJEM, Lioté F, Naden RP, Nuki G, Ogdie A, Perez-Ruiz F, Saag K, Singh JA, Sundy JS, Tausche AK, Vaquez-Mellado J, Yarows SA, Taylor WJ. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2015; 74:1789-98. [PMID: 26359487 PMCID: PMC4602275 DOI: 10.1136/annrheumdis-2015-208237] [Citation(s) in RCA: 439] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective Existing criteria for the classification of gout have suboptimal sensitivity and/or specificity, and were developed at a time when advanced imaging was not available. The current effort was undertaken to develop new classification criteria for gout. Methods An international group of investigators, supported by the American College of Rheumatology and the European League Against Rheumatism, conducted a systematic review of the literature on advanced imaging of gout, a diagnostic study in which the presence of monosodium urate monohydrate (MSU) crystals in synovial fluid or tophus was the gold standard, a ranking exercise of paper patient cases, and a multi-criterion decision analysis exercise. These data formed the basis for developing the classification criteria, which were tested in an independent data set. Results The entry criterion for the new classification criteria requires the occurrence of at least one episode of peripheral joint or bursal swelling, pain, or tenderness. The presence of MSU crystals in a symptomatic joint/bursa (ie, synovial fluid) or in a tophus is a sufficient criterion for classification of the subject as having gout, and does not require further scoring. The domains of the new classification criteria include clinical (pattern of joint/bursa involvement, characteristics and time course of symptomatic episodes), laboratory (serum urate, MSU-negative synovial fluid aspirate), and imaging (double-contour sign on ultrasound or urate on dual-energy CT, radiographic gout-related erosion). The sensitivity and specificity of the criteria are high (92% and 89%, respectively). Conclusions The new classification criteria, developed using a data-driven and decision-analytic approach, have excellent performance characteristics and incorporate current state-of-the-art evidence regarding gout.
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Affiliation(s)
- Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Tim L Th A Jansen
- Viecuri Medical Center, Venlo, The Netherlands Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jaap Fransen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Hyon Choi
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | | | - Frédéric Lioté
- INSERM UMR 1132, Hôpital Lariboisière, AP-HP, and Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Raymond P Naden
- McMaster University Medical Centre, Hamilton, Ontario, Canada
| | | | - Alexis Ogdie
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fernando Perez-Ruiz
- Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya, Spain
| | - Kenneth Saag
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jasvinder A Singh
- Birmingham VA Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - John S Sundy
- Duke University and Duke University Medical Center, Durham, North Carolina, USA Gilead Sciences, Foster City, California, USA
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Neogi T, Jansen TLTA, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJEM, Lioté F, Naden RP, Nuki G, Ogdie A, Perez‐Ruiz F, Saag K, Singh JA, Sundy JS, Tausche A, Vaquez‐Mellado J, Yarows SA, Taylor WJ. 2015 Gout Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol 2015; 67:2557-68. [PMID: 26352873 PMCID: PMC4566153 DOI: 10.1002/art.39254] [Citation(s) in RCA: 334] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 06/18/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Existing criteria for the classification of gout have suboptimal sensitivity and/or specificity, and were developed at a time when advanced imaging was not available. The current effort was undertaken to develop new classification criteria for gout. METHODS An international group of investigators, supported by the American College of Rheumatology and the European League Against Rheumatism, conducted a systematic review of the literature on advanced imaging of gout, a diagnostic study in which the presence of monosodium urate monohydrate (MSU) crystals in synovial fluid or tophus was the gold standard, a ranking exercise of paper patient cases, and a multicriterion decision analysis exercise. These data formed the basis for developing the classification criteria, which were tested in an independent data set. RESULTS The entry criterion for the new classification criteria requires the occurrence of at least 1 episode of peripheral joint or bursal swelling, pain, or tenderness. The presence of MSU crystals in a symptomatic joint/bursa (i.e., synovial fluid) or in a tophus is a sufficient criterion for classification of the subject as having gout, and does not require further scoring. The domains of the new classification criteria include clinical (pattern of joint/bursa involvement, characteristics and time course of symptomatic episodes), laboratory (serum urate, MSU-negative synovial fluid aspirate), and imaging (double-contour sign on ultrasound or urate on dual-energy computed tomography, radiographic gout-related erosion). The sensitivity and specificity of the criteria are high (92% and 89%, respectively). CONCLUSION The new classification criteria, developed using a data-driven and decision analytic approach, have excellent performance characteristics and incorporate current state-of-the-art evidence regarding gout.
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Affiliation(s)
- Tuhina Neogi
- Boston University School of MedicineBostonMassachusetts
| | - Tim L. Th. A. Jansen
- Viecuri Medical Center, Venlo, The Netherlands, and Radboud University Medical CenterNijmegenThe Netherlands
| | | | - Jaap Fransen
- Radboud University Medical CenterNijmegenThe Netherlands
| | | | | | | | - Hyon Choi
- Boston University School of MedicineBostonMassachusetts
| | | | | | - Frédéric Lioté
- Frédéric Lioté, MD, PhD: INSERM UMR 1132Hôpital Lariboisière, AP‐HP, and Université Paris DiderotSorbonne Paris Cité, ParisFrance
| | | | | | | | - Fernando Perez‐Ruiz
- Hospital Universitario Cruces and BioCruces Health Research InstituteVizcayaSpain
| | | | - Jasvinder A. Singh
- Birmingham VA Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of MedicineRochester Minnesota
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Stewart S, Dalbeth N, Vandal AC, Rome K. Characteristics of the first metatarsophalangeal joint in gout and asymptomatic hyperuricaemia: a cross-sectional observational study. J Foot Ankle Res 2015; 8:41. [PMID: 26288657 PMCID: PMC4539719 DOI: 10.1186/s13047-015-0091-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/18/2015] [Indexed: 12/26/2022] Open
Abstract
Background This study aimed to identify patient-reported outcomes and clinician-assessed characteristics of the first metatarsophalangeal joint (1MTPJ) in people with gout and with asymptomatic hyperuricaemia by comparing them to normouricaemic controls. Methods Twenty four people with gout (without current symptoms of acute arthritis), 29 with asymptomatic hyperuricaemia and 34 age- and sex-matched controls participated in this cross-sectional observational study. Patient-reported outcomes included 1MTPJ pain, foot pain and disability, body pain, lower limb function, activity limitation and overall wellbeing. Clinician-assessed characteristics of the 1MTPJ included range of motion (ROM), plantar- and dorsi-flexion force, foot posture, temperature and hallux valgus severity. Results Compared to controls, participants with gout reported greater 1MTPJ pain (p = 0.014), greater foot pain and disability (p < 0.001), increased odds of having disabling foot pain (odds ratio (OR) 13.4, p < 0.001), decreased lower limb function for daily living (p = 0.002) and recreational (p < 0.001) activities, increased activity limitation (p = 0.002), reduced overall wellbeing (p = 0.034), reduced ROM (p < 0.001), reduced plantarflexion force (p = 0.012), increased 1MTPJ plantar (p = 0.004), dorsal (p = 0.003) and medial (p = 0.004) temperature and had increased odds of having more severe hallux valgus (OR 0.3 p = 0.041). Compared to controls, participants with asymptomatic hyperuricaemia had increased odds of having disabling foot pain (OR 4.2, p = 0.013), increased activity limitation (p = 0.033), decreased lower limb function for daily living (p = 0.026) and recreational (p = 0.010) activities, increased 1MTPJ plantarflexion force (p = 0.004) and a more pronated foot type (p = 0.036). Conclusions People with gout demonstrate 1MTPJ-specific changes indicative of subclinical inflammation, even in the absence of acute arthritis. People with asymptomatic hyperuricaemia, who exhibit no features or symptoms of gout, also report high levels of foot- and lower limb-related pain and disability.
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Affiliation(s)
- Sarah Stewart
- Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand
| | - Nicola Dalbeth
- Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand ; Department of Rheumatology, Auckland District Health Board, P.O. Box 92189, Auckland, New Zealand
| | - Alain C Vandal
- Department of Biostatistics & Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand ; Health Intelligence & Informatics, Ko Awatea, Counties Manukau Health, Private Bag 93311, Auckland, 1640 New Zealand
| | - Keith Rome
- Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142 New Zealand
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Dehlin M, Stasinopoulou K, Jacobsson L. Validity of gout diagnosis in Swedish primary and secondary care - a validation study. BMC Musculoskelet Disord 2015; 16:149. [PMID: 26077041 PMCID: PMC4466844 DOI: 10.1186/s12891-015-0614-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 06/01/2015] [Indexed: 11/10/2022] Open
Abstract
Background The diagnostic golden standard for gout is to detect monosodium urate (MSU) crystals in synovial fluid. While some gout classification criteria include this variable, most gout diagnoses are based on clinical features. This discrepancy between clinical practice and classification criteria can hinder gout epidemiological studies. Here, the objective was to validate gout diagnoses (International Classification of Diseases (ICD)-10 gout codes) in primary and secondary care relative to five classification criteria (Rome, New York, ARA, Mexico, and Netherlands). The frequency with which MSU crystal identification was used to establish gout diagnosis was also determined. Methods In total, 394 patients with ≥1 ICD-10 gout diagnosis between 2009 and 2013 were identified from the medical records of two primary care centers (n = 262) and one secondary care center (n = 132) in Gothenburg, Sweden. Medical records were assessed for all classification criteria. Results Primary care patients met criteria cutoffs more frequently when ≥2 gout diagnoses were made. Even then, few primary care patients met the Rome and New York cutoffs (19 % and 8 %, respectively). The ARA, Mexico, and Netherlands cutoffs were met more frequently by primary care patients with ≥2 gout diagnoses (54 %, 81 %, and 80 %, respectively). Mexico and Netherlands cutoffs were met more frequently by the rheumatology department patients (80 % and 71 %, respectively), even when patients with only 1 gout diagnosis were included. Analysis of MSU crystals served to establish gout diagnoses in only 27 % of rheumatology department and 2 % of primary care cases. Conclusions If a patient was deemed to have gout at ≥2 primary care center or ≥1 rheumatology-center visits according to an ICD-10 gout code, the positive predictive value of this variable in relation with the Mexico and Netherlands classification criteria was ≥80 % for both primary care and rheumatology care settings in Sweden. MSU crystal identification was rarely used to establish gout diagnosis. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0614-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mats Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, P.O. Box 480, 405 30, Gothenburg, Sweden.
| | - Kalliopi Stasinopoulou
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, P.O. Box 480, 405 30, Gothenburg, Sweden.
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, P.O. Box 480, 405 30, Gothenburg, Sweden.
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Schlesinger N, Radvanski DC, Young TC, McCoy JV, Eisenstein R, Moore DF. Diagnosis and Treatment of Acute Gout at a University Hospital Emergency Department. Open Rheumatol J 2015; 9:21-6. [PMID: 26106456 PMCID: PMC4475690 DOI: 10.2174/18743129014090100021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/30/2015] [Accepted: 05/04/2015] [Indexed: 11/22/2022] Open
Abstract
Background : Acute gout attacks account for a substantial number of visits to the emergency department (ED). Our aim was to evaluate acute gout diagnosis and treatment at a University Hospital ED. Methods : Our study was a retrospective chart review of consecutive patients with a diagnosis of acute gout seen in the ED 1/01/2004 - 12/31/2010. We documented: demographics, clinical characteristics, medications given, diagnostic tests, consultations and whether patients were hospitalized. Descriptive and summary statistics were performed on all variables. Results : We found 541 unique ED visit records of patients whose discharge diagnosis was acute gout over a 7 year period. 0.13% of ED visits were due to acute gout. The mean patient age was 54; 79% were men. For 118 (22%) this was their first attack. Attack duration was ≤ 3 days in 75%. Lower extremity joints were most commonly affected. Arthrocentesis was performed in 42 (8%) of acute gout ED visits. During 355 (66%) of ED visits, medications were given in the ED and/or prescribed. An anti-inflammatory drug was given during the ED visit during 239 (44%) visits. Medications given during the ED visit included: NSAIDs: 198 (56%): opiates 190 (54%); colchicine 32 (9%) and prednisone 32 (9%). During 154 (28%) visits an anti-inflammatory drug was prescribed. Thirty two (6%) were given no medications during the ED visit nor did they receive a prescription. Acute gout rarely (5%) led to hospitalizations. Conclusion : The diagnosis of acute gout in the ED is commonly clinical and not crystal proven. Anti-inflammatory drugs are the mainstay of treatment in acute gout; yet, during more than 50% of ED visits, anti-inflammatory drugs were not given during the visit. Thus, improvement in the diagnosis and treatment of acute gout in the ED may be required.
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Affiliation(s)
- Naomi Schlesinger
- Division of Rheumatology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Diane C Radvanski
- Division of Rheumatology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Tina C Young
- Department of Biostatistics, Rutgers School of Public Health Piscataway, NJ, USA
| | - Jonathan V McCoy
- Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Robert Eisenstein
- Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dirk F Moore
- Department of Biostatistics, Rutgers School of Public Health Piscataway, NJ, USA
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Experiences of gout-related disability from the patients' perspective: a mixed methods study. Clin Rheumatol 2015; 33:1145-54. [PMID: 24077900 DOI: 10.1007/s10067-013-2400-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/10/2013] [Accepted: 09/17/2013] [Indexed: 01/22/2023]
Abstract
Disability is a common problem in patients with gout. Recently, the Health Assessment Questionnaire Disability Index (HAQ-DI) was recommended for assessing patient reported activity limitations in gout. However, few studies have explored experiences and issues of disability from the perspective of gout patients themselves. The objectives of this study were to explore disability issues in patients with gout and to examine the content validity of the HAQ-DI in this patient group. Two studies were performed: a semi-structured interview study with seven male gout patients and a cross-sectional survey study among 34 other patients with gout. In both studies, specific examples of activity limitations were elicited using open-ended methods. The survey study additionally aimed to quantify the relevance of the activities listed in the HAQ-DI. Most patients experienced several gout attacks in the previous year. Limitations were reported to occur during a flare, but patients were generally not limited between attacks. During an attack, patients mainly experienced limitations related to mobility, especially walking and climbing stairs. Patients also mentioned limitations in activities related to domestic life, such as gardening and doing housework. Limitations related to self-care or activities requiring the use of the upper extremities were rarely mentioned. Corresponding HAQ-DI items were skewed towards very low disability scores over the past week. Assessments of gout-related disability should particularly focus on mobility and lower extremity functioning and should consider the intermittent nature of the disease. The HAQ-DI may not adequately meet these requirements, suggesting the need to explore other measures of gout-related disability
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Stewart S, Dalbeth N, McNair P, Parmar P, Gow P, Rome K. The effect of good and poor walking shoe characteristics on plantar pressure and gait in people with gout. Clin Biomech (Bristol, Avon) 2014; 29:1158-63. [PMID: 25304642 DOI: 10.1016/j.clinbiomech.2014.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/15/2014] [Accepted: 09/23/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous research has shown that good footwear characteristics may reduce foot pain and foot-related disability in people with gout. The aim of this study was to determine the effect of good and poor footwear characteristics on plantar pressure and spatiotemporal parameters of gait in people with gout. METHODS Thirty-six people with gout participated in a cross-sectional repeated measures study. Plantar pressure and spatiotemporal parameters were recorded in two shoe conditions: (1) the participants own footwear, and (2) either a new pair of walking shoes with good footwear characteristics (n=21) or poor characteristics (n=15). Differences between good and poor shoe groups compared to participants own shoes were also determined. FINDINGS Compared to participant's own shoes, footwear with good characteristics significantly reduced peak pressure at metatarsal 3 and 5, reduced pressure time integrals beneath the heel and metatarsals 3 and 5 and increased pressure time integrals beneath the midfoot. The footwear with poor characteristics significantly increased peak pressure beneath the heel and lesser toes, reduced peak pressure at metatarsal 3 and reduced pressure time integrals in the midfoot compared to participants own shoes. Both good and poor footwear significantly increased walking velocity, step length, and stride length compared to participants own shoes. INTERPRETATION Walking shoes with good footwear characteristics can influence plantar pressure values and encourage a more efficient heel to toe gait pattern in people with gout. These changes may contribute to the reduction in foot pain and foot-related problems in this population.
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Affiliation(s)
- Sarah Stewart
- Health and Rehabilitation Research Institute, Auckland University of Technology, AUT North Shore Campus, Private Bag 92006, Auckland 1142, New Zealand.
| | - Nicola Dalbeth
- Counties Manukau District Health Board, Private Bag 94052, South Auckland Mail Centre, Manukau, Auckland 2240, New Zealand; Faculty of Health and Environmental Sciences, Auckland University of Technology, AUT North Shore Campus, Private Bag 92006, Auckland 1142, New Zealand
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, AUT North Shore Campus, Private Bag 92006, Auckland 1142, New Zealand
| | - Priya Parmar
- The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; Auckland District Health Board, Private Bag 92024, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Peter Gow
- Counties Manukau District Health Board, Private Bag 94052, South Auckland Mail Centre, Manukau, Auckland 2240, New Zealand
| | - Keith Rome
- Health and Rehabilitation Research Institute, Auckland University of Technology, AUT North Shore Campus, Private Bag 92006, Auckland 1142, New Zealand
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García-Méndez S, Arreguín-Reyes R, López-López O, Vázquez-Mellado J. Frequency of gout according to the perception of physicians in México. ACTA ACUST UNITED AC 2013; 10:197-8. [PMID: 24035796 DOI: 10.1016/j.reuma.2013.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/29/2013] [Accepted: 06/02/2013] [Indexed: 10/26/2022]
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Dalbeth N, Fransen J, Jansen TL, Neogi T, Schumacher HR, Taylor WJ. New classification criteria for gout: a framework for progress. Rheumatology (Oxford) 2013; 52:1748-53. [PMID: 23611919 DOI: 10.1093/rheumatology/ket154] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The definitive classification or diagnosis of gout normally relies upon the identification of MSU crystals in SF or from tophi. Where microscopic examination of SF is not available or is impractical, the best approach may differ depending upon the context. For many types of research, clinical classification criteria are necessary. The increasing prevalence of gout, advances in therapeutics and the development of international research collaborations to understand the impact, mechanisms and optimal treatment of this condition emphasize the need for accurate and uniform classification criteria for gout. Five clinical classification criteria for gout currently exist. However, none of the currently available criteria has been adequately validated. An international project is currently under way to develop new validated gout classification criteria. These criteria will be an essential step forward to advance the research agenda in the modern era of gout management.
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Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand.
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