Definitive Diagnosis of Gout by Identification of Urate Crystals in Asymptomatic Metatarsophalangeal Joints

Agudelo, Carlos A.; Weinberger, Abraham; Schumacher, H. Ralph; Turner, Robert A.; Molina, Javier

doi:10.1002/art.1780220521

Cited by 55 publications

(16 citation statements)

References 6 publications

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“…Without doubt, the gold standard for diagnosis of gout is identification of crystals on aspirates from synovial fluid or tophus. However, although intercritical joint aspiration is a useful diagnostic technique,20 – 25 the requirement to undergo aspiration might have further reduced the number of people agreeing to participate in the clinical assessment, particularly as only 4% had experienced joint aspiration previously (data not shown). As an alternative to crystal identification, many studies of gout have used the 1977 ARA preliminary criteria as diagnostic criteria 8.…”

Section: Discussionmentioning

confidence: 99%

Concordance of the management of chronic gout in a UK primary-care population with the EULAR gout recommendations

Roddy

Zhang

Doherty

2007

Annals of the Rheumatic Diseases

197

141

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Objectives: To assess concordance of the management of chronic gout in UK primary care with the European League Against Rheumatism (EULAR) gout recommendations. Methods: A postal questionnaire was sent to all adults aged .30 years registered with two general practices. Patients with possible gout attended for clinical assessment, at which the diagnosis was verified clinically. Aspects of chronic gout management, including provision of lifestyle modification advice, use of uratelowering therapies (ULT) including dose titration to serum urate (SUA) level, prophylaxis against acute attacks, and diuretic cessation were assessed in accordance with the EULAR recommendations. Results: Of 4249 (32%) completed questionnaires returned, 488 reported gout or acute attacks and were invited for clinical assessment. Of 359 attendees, 164 clinically confirmed cases of gout were identified. Advice regarding alcohol consumption was recalled by 59 (41%), weight loss by 36 (25%) and diet by 42 (29%). Allopurinol was the only ULT used and was taken by 44 (30%); 31 (70%) were taking 300 mg daily. Mean SUA was lower in allopurinol users than non-users (318 vs 434 mmol/l) and was less often .360 mmol/l in allopurinol users (23% vs 75%). Eight patients had recently commenced allopurinol; two of these also were taking prophylactic colchicine or non-steroidal anti-inflammatory drugs. Of 25 patients with diuretic-induced gout, 16 (64%) were still taking a diuretic. Conclusion: Treatment of chronic gout is often suboptimal and poorly concordant with EULAR recommendations. Lifestyle advice is infrequently offered, and allopurinol is restricted to a minority. Persistent hyperuricaemia was often seen in allopurinol non-users, but was also in allopurinol users, suggesting that doses .300 mg are often necessary.

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Section: Discussionmentioning

confidence: 99%

Concordance of the management of chronic gout in a UK primary-care population with the EULAR gout recommendations

Roddy

Zhang

Doherty

2007

Annals of the Rheumatic Diseases

197

141

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“…Visible deposits have been associated with more attacks of arthritis and more polyarticular involvement (37). The formation of urate deposits as seen in tophaceous gout appears to be gradual and painless; tophi may be universal in the gouty population, given the frequent identification of urate crystals, even in asymptomatic joints (38). What factor(s) might influence or precipitate the inflammatory reaction to crystals has been under intense study (39)(40)(41)(42)(43)(44)(45)(46); however, many questions remain unanswered.…”

Section: Discussionmentioning

confidence: 99%

Gout nodulosis: Widespread subcutaneous deposits without gout

Antonio¹,

Londoño²,

Saaibi³

et al. 1996

Arthritis & Rheumatism

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“…It has been observed for several years that MSU and CPPD crystals can be identified in asymptomatic previously involved gouty joints [13]. Pascual et al [14] aspirated 80 knees and 21 first metatarsophalangeal joints during the Crystal identification in joint fluid has been an essential part of diagnosis of joint disease.…”

Section: Identifying Birefringent Crystalsmentioning

confidence: 98%

“…Fluoroscopy was validated to lead to accurate shoulder entry in 16 of 18 patients [29]. First, metatarsophalangeal joints as a common site of gout can be entered even between attacks with flexion and stretching on the toe [13], although optimal methods (eg, needle size) have not been systematically evaluated. Apatite Crystal Identification red or von Kossa staining offers practical value for individual use.…”

Section: Arthrocentesesmentioning

confidence: 99%