Diagnosis of Chronic Gout: Evaluating the American College of Rheumatology Proposal, European League Against Rheumatism Recommendations, and Clinical Judgment

Peláez‐Ballestas, Ingris; Cuevas, Claudia; Burgos‐Vargas, Rubén; Roque, Lizandra Hernández; Terán, Leobardo; Espinoza, Jesús; Esquivel-Valerio, Jorge Antonio; Goycochea-Robles, María Victoria; Aceves, Francisco J.; Bernard, Ana Guilaisne; Ventura, L.; Shumsky, Clara; Garduño, Adolfo Hernández; Vázquez‐Mellado, Janitzia

doi:10.3899/jrheum.091385

Cited by 53 publications

(33 citation statements)

References 19 publications

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“…To be included in our systematic review, the enrolled subjects had to be diagnosed as gouty arthritis according to ascertained diagnostic criteria: European League Against Rheumatism (EULAR) criteria, the American Rheumatism Association (ARA) preliminary classification criteria for acute gout 1977 [15], Mexico 2010 [16], Netherland 2010 [17], or the Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in TCM issued by the State Administration of TCM [18]. No restrictions on race, age, and sex were imposed.…”

Section: Methodsmentioning

confidence: 99%

Update on the Clinical Effect of Acupuncture Therapy in Patients with Gouty Arthritis: Systematic Review and Meta‐Analysis

Zhang

et al. 2016

Evidence-Based Complementary and Alternative Medicine

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Objective. The aim of this study is to evaluate the clinical efficacy and safety of acupuncture therapy in the treatment of acute gouty arthritis. Methods. A literature search of PubMed, EMBASE, ISI Web of Science, CENTRAL, and CNKI was conducted from the inception date of each database up to October 2015. Two investigators screened each article independently and were blinded to the findings of the other reviewer. Data was extracted according to the predetermined collection form. Meta-analysis was performed. Results. We analyzed data from 28 RCTs involving 2237 patients with gouty arthritis. Compared with conventional pharmacological treatments acupuncture was more effective in rendering patients free from symptoms after 24 hours, lowering serum urate, alleviating pain associated with gouty arthritis, and decreasing the ESR; regarding CRP, no statistically significant difference was found. In addition, the frequency of adverse events in acupuncture treatment was lower than that in control group. Conclusion. Based on the findings of our study, we cautiously suggest that acupuncture is an effective and safe therapy for patients with gouty arthritis. However, the potential beneficial effect of acupuncture might be overstated due to the methodological deficiency of included studies. High quality RCTs with larger scale are encouraged.

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Section: Methodsmentioning

confidence: 99%

Update on the Clinical Effect of Acupuncture Therapy in Patients with Gouty Arthritis: Systematic Review and Meta‐Analysis

Zhang

et al. 2016

Evidence-Based Complementary and Alternative Medicine

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“…The earliest were the 1963 Rome [9] and 1966 New York (NY) [10] criteria, which relied largely on the presence of tophi and the detection of IC MSU crystals in the SF (Table 1). Subsequent criteria, namely, the 1977 ARA [11] and the 2010 Mexico [12] criteria, incorporated several clinical characteristics of gout that are often used in clinical practice, such as monoarthritis with rapid onset and pronounced signs of inflammation. The Netherlands criteria were published in 2010, emphasizing clinical parameters and not primarily considering synovial fluid analysis [13].…”

Section: Introductionmentioning

confidence: 99%

Validity of gout diagnosis in Swedish primary and secondary care - a validation study

Dehlin

Stasinopoulou

Jacobsson

2015

BMC Musculoskelet Disord

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BackgroundThe 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.MethodsIn 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.ResultsPrimary 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.ConclusionsIf 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 materialThe 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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“…The comparison criteria sets from published studies were the 1977 ARA preliminary criteria (survey and complete format),3 an abbreviated form of the ARA criteria (Mexico),12 a criteria set developed in primary care (Netherlands),6 the Rome13 and New York14 criteria and modified versions of the Mexico, Rome and New York criteria that excluded SF/tissue microscopy. The details of these criteria are shown in online supplementary table S1.…”

Section: Methodsmentioning

confidence: 99%

Performance of classification criteria for gout in early and established disease

et al. 2014

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Existing classification criteria for gout have sensitivity of over 80% in early and established disease but currently available criteria that do not require synovial fluid analysis have inadequate specificity especially later in the disease. Classification criteria for gout with better specificity are required, although the findings should be cautiously applied to non-rheumatology clinic populations.

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Diagnosis of Chronic Gout: Evaluating the American College of Rheumatology Proposal, European League Against Rheumatism Recommendations, and Clinical Judgment

Abstract: Current or past history of >or= 4/8 CGD parameters is highly suggestive of chronic gout.

Cited by 53 publications

References 19 publications

Update on the Clinical Effect of Acupuncture Therapy in Patients with Gouty Arthritis: Systematic Review and Meta‐Analysis

Update on the Clinical Effect of Acupuncture Therapy in Patients with Gouty Arthritis: Systematic Review and Meta‐Analysis

Validity of gout diagnosis in Swedish primary and secondary care - a validation study

Performance of classification criteria for gout in early and established disease

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