Gout: Difference between revisions
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[[Gout history and symptoms|History and Symptoms]] | [[Gout physical examination|Physical Examination]] | [[Gout laboratory findings|Laboratory Findings]] | [[Gout x ray|X Ray]] | [[Gout ultrasonograpy|Ultrasonograpy]] |[[Gout CT|CT]] | [[Gout MRI|MRI]] | [[Gout history and symptoms|History and Symptoms]] | [[Gout physical examination|Physical Examination]] | [[Gout laboratory findings|Laboratory Findings]] | [[Gout x ray|X Ray]] | [[Gout ultrasonograpy|Ultrasonograpy]] |[[Gout CT|CT]] | [[Gout MRI|MRI]] | ||
{| class="wikitable" align="right" | |||
|+ Accuracy of diagnostic criteria for gout among patients who had [[synovial fluid]] analysis | |||
<ref name="pmid19125136">{{cite journal| author=Malik A, Schumacher HR, Dinnella JE, Clayburne GM| title=Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis. | journal=J Clin Rheumatol | year= 2009 | volume= 15 | issue= 1 | pages= 22-4 | pmid=19125136 | doi=10.1097/RHU.0b013e3181945b79 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19125136 }} </ref> | |||
! !! Criteria!!Sensitivity !! Specificity | |||
|- | |||
| ARA (ACR)||6 of 12 criteria||align="center"| 70% ||align="center"| 79% | |||
|- | |||
| Rome||2 of 4 criteria:<br/>• Painful joint swelling, abrupt onset, Clearing in 1-2 weeks initially<br/>• Serum uric acid: >7 in males; >6 in females<br/>• Presence of tophi<br/>• Urate crystals in synovial fluid or tissues||align="center"| 70% ||align="center"| 83% | |||
|- | |||
| New York||2 of 5 criteria:<br/>• 2 attacks of painful limb joint swelling<br/>• Abrupt onset and remission in 1—2 weeks initially<br/>• First MTP attack<br/>• Presence of a tophus<br/>• Response to colchicine-major reduction in inflammation within 48 h||align="center"| 67% ||align="center"| 89% | |||
|} | |||
Several sets of diagnostic criteria exit (see table).<ref name="pmid19125136">{{cite journal| author=Malik A, Schumacher HR, Dinnella JE, Clayburne GM| title=Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis. | journal=J Clin Rheumatol | year= 2009 | volume= 15 | issue= 1 | pages= 22-4 | pmid=19125136 | doi=10.1097/RHU.0b013e3181945b79 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19125136 }} </ref> | |||
{| class="wikitable" align="right" | |||
|+ The serum uric acid level during an attack of gout<ref name="pmid20625017">{{cite journal| author=Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M| title=A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. | journal=Arch Intern Med | year= 2010 | volume= 170 | issue= 13 | pages= 1120-6 | pmid=20625017 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20625017 | doi=10.1001/archinternmed.2010.196 }} </ref><ref name="pmid19369457">{{cite journal |author=Schlesinger N, Norquist JM, Watson DJ |title=Serum urate during acute gout |journal=J. Rheumatol. |volume=36 |issue=6 |pages=1287–9 |year=2009 |month=June |pmid=19369457 |doi=10.3899/jrheum.080938 |url=http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=19369457 |issn=}}</ref> | |||
! !! Sensitivity !! Specificity | |||
|- | |||
| > 5.88 mg/dl<ref name="pmid20625017"/>|| align="center"|95%|| align="center"|53% | |||
|- | |||
| ≥ 6 mg/dl<ref name="pmid19369457"/>||align="center"| 86% ||align="center"| ? | |||
|- | |||
| ≥ 8 mg/dl<ref name="pmid19369457"/>|| align="center"|68% || align="center"|? | |||
|} | |||
A [[clinical prediction rule]] (link to online version<ref name="pmid26926810">{{cite journal| author=Sylvester JE, Leggit JC| title=Diagnostic Tool for Gout Without Need for Joint Fluid Aspiration. | journal=Am Fam Physician | year= 2016 | volume= 93 | issue= 4 | pages= 256-8 | pmid=26926810 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26926810 }} </ref>) found that the following predicted urate crystals by aspiration:<ref name="pmid20625017">{{cite journal| author=Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M| title=A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. | journal=Arch Intern Med | year= 2010 | volume= 170 | issue= 13 | pages= 1120-6 | pmid=20625017 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20625017 | doi=10.1001/archinternmed.2010.196 }} </ref> | |||
* Male | |||
* Onset within one day | |||
* Joint redness | |||
* First metatarsaophalangeal joint | |||
* Previous arthritis attack per patient | |||
* History of hypertension or 1 or more [[cardiovascular disease]]s | |||
* Serum [[uric acid]] level > 5.88 mg/dl | |||
However, among patients with high scores, 20% did not have crystals. Only one of 381 patients had bacterial arthritis. | |||
==Treatment== | ==Treatment== | ||
Revision as of 13:44, 17 August 2017
For patient information click here
| Gout | |
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| Tophaceous Gout (Image courtesy of Charlie Goldberg, M.D.) |
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Gout Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Gout On the Web |
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American Roentgen Ray Society Images of Gout |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Synonyms and keywords: Urate crystal arthropathy; uric acid crystal deposition in joint; gouty arthritis; podagra
Overview
Historical Perspective
Pathophysiology
Differentiating Gout from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | X Ray | Ultrasonograpy |CT | MRI
| Criteria | Sensitivity | Specificity | |
|---|---|---|---|
| ARA (ACR) | 6 of 12 criteria | 70% | 79% |
| Rome | 2 of 4 criteria: • Painful joint swelling, abrupt onset, Clearing in 1-2 weeks initially • Serum uric acid: >7 in males; >6 in females • Presence of tophi • Urate crystals in synovial fluid or tissues |
70% | 83% |
| New York | 2 of 5 criteria: • 2 attacks of painful limb joint swelling • Abrupt onset and remission in 1—2 weeks initially • First MTP attack • Presence of a tophus • Response to colchicine-major reduction in inflammation within 48 h |
67% | 89% |
Several sets of diagnostic criteria exit (see table).[1]
| Sensitivity | Specificity | |
|---|---|---|
| > 5.88 mg/dl[2] | 95% | 53% |
| ≥ 6 mg/dl[3] | 86% | ? |
| ≥ 8 mg/dl[3] | 68% | ? |
A clinical prediction rule (link to online version[4]) found that the following predicted urate crystals by aspiration:[2]
- Male
- Onset within one day
- Joint redness
- First metatarsaophalangeal joint
- Previous arthritis attack per patient
- History of hypertension or 1 or more cardiovascular diseases
- Serum uric acid level > 5.88 mg/dl
However, among patients with high scores, 20% did not have crystals. Only one of 381 patients had bacterial arthritis.
Treatment
Medical Therapy | Surgery | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Case Studies
Related Chapter
External Links
- "Answers and Questions on Gout". U.S. National Institutes of Health—National Institute of Arthritis and Musculoskeletal and Skin Diseases. September 28th, 2007. Retrieved 2007-08-28. Check date values in:
|date=(help) - "Coffee Consumption and Reduced Gout Risk". Drinking coffee reduces risk of gout in middle age men. U.S. National Institutes of Health. Retrieved 2007-05-25.
Template:Diseases of the musculoskeletal system and connective tissue
ar:نقرس bg:Подагра cs:Dna da:Gigt de:Gicht eo:Podagro fa:نقرس io:Kiragro id:Gout it:Gotta he:שיגדון lb:Giicht ms:Gout nl:Jicht no:Urinsyregikt sk:Dna sr:Гихт fi:Kihti sv:Gikt te:గౌటు
- ↑ 1.0 1.1 Malik A, Schumacher HR, Dinnella JE, Clayburne GM (2009). "Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis". J Clin Rheumatol. 15 (1): 22–4. doi:10.1097/RHU.0b013e3181945b79. PMID 19125136.
- ↑ 2.0 2.1 2.2 Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M (2010). "A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis". Arch Intern Med. 170 (13): 1120–6. doi:10.1001/archinternmed.2010.196. PMID 20625017.
- ↑ 3.0 3.1 3.2 Schlesinger N, Norquist JM, Watson DJ (2009). "Serum urate during acute gout". J. Rheumatol. 36 (6): 1287–9. doi:10.3899/jrheum.080938. PMID 19369457. Unknown parameter
|month=ignored (help) - ↑ Sylvester JE, Leggit JC (2016). "Diagnostic Tool for Gout Without Need for Joint Fluid Aspiration". Am Fam Physician. 93 (4): 256–8. PMID 26926810.