Gout: Difference between revisions
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==[[Diagnosis]]== | ==[[Diagnosis]]== | ||
{| class="wikitable" align=" | The favored approach to the diagnosis of gout is based upon the identification of intracellular monosodium urate (MSU) crystals found in the synovial fluid aspirate of an affected joint, under polarizing light microscopy. But when this is not possible, a clinical diagnosis can be deduced with the help of classical clinical features, including the history and physical examination, laboratory findings, and various imaging studies. | ||
{| class="wikitable" align="center" | |||
|+ Accuracy of diagnostic criteria for gout among patients who had [[synovial fluid]] analysis | |+ 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> | <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> | ||
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| 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% | | 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> | 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> | ||
Revision as of 10:11, 17 April 2018
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
The favored approach to the diagnosis of gout is based upon the identification of intracellular monosodium urate (MSU) crystals found in the synovial fluid aspirate of an affected joint, under polarizing light microscopy. But when this is not possible, a clinical diagnosis can be deduced with the help of classical clinical features, including the history and physical examination, laboratory findings, and various imaging studies.
| 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.
References
- ↑ 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.
Template:Diseases of the musculoskeletal system and connective tissue
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