Diagnostic Value of Clinical, Laboratory, and Imaging Findings in Patients with a Clinical Suspicion of Gout: A Systematic Literature Review

Sivera, Francisca; Andrés, Mariano; Falzon, Louise; Heijde, D.M.F.M. van der; Carmona, Loreto

doi:10.3899/jrheum.140456

Cited by 21 publications

(15 citation statements)

References 27 publications

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“…One of the strengths of the current study was confirmation of the presence of MSU crystals by compensated polarized microscopy. Despite the observation that some ultrasound‐defined signs (i.e., the double contour sign) have good diagnostic performance in gout , to date none of them is a substitute for SF analysis as the gold standard for diagnosing crystal‐related arthritis . In fact, in the present study the specific signs observed on ultrasound scans (double contour sign, tophi) alone showed no association with coronary outcomes, thus precluding the classification of patients with asymptomatic hyperuricemia using ultrasonography without microscopy verification.…”

Section: Discussioncontrasting

confidence: 66%

Silent Monosodium Urate Crystal Deposits Are Associated With Severe Coronary Calcification in Asymptomatic Hyperuricemia: An Exploratory Study

Andrés

Quintanilla

Sivera

et al. 2016

Arthritis & Rheumatology

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Objective. To evaluate the association between monosodium urate (MSU) crystal deposits in patients with asymptomatic hyperuricemia and the severity and extension of coronary artery disease (CAD).Methods. In this cross-sectional study, consecutive inpatients with a non-ST elevation acute coronary event and asymptomatic hyperuricemia (serum uric acid concentration of ‡7.0 mg/dl) or normouricemia (serum uric acid concentration of <7.0 mg/dl) were enrolled. In patients with asymptomatic hyperuricemia, the presence of MSU crystals was determined by ultrasound evaluation of both knees and first metatarsophalangeal joints and by compensated polarized light microscopy. CAD was assessed by coronary angiography, and the following variables were considered: 1) the presence of moderate-to-severe coronary artery calcification, 2) the number of significant coronary stenoses, and 3) the presence of multivessel disease. The association between variables indicating the severity of CAD and the presence of MSU crystals was analyzed by multivariate regression.Results. One hundred forty patients were enrolled. After ultrasonography and microscopic analyses were performed, the patients were classified as having normouricemia (n 5 66), asymptomatic hyperuricemia alone (n 5 61), and asymptomatic hyperuricemia with MSU crystals (n 5 13). The prevalence of moderate-to-severe coronary calcification was significantly higher in the patients with asymptomatic hyperuricemia with MSU crystals compared with patients with asymptomatic hyperuricemia alone and patients with normouricemia (P 5 0.003). An independent association was observed between the presence of moderateto-severe calcification and asymptomatic hyperuricemia with crystals (odds ratio 16.8, P 5 0.002). No significant association was observed for the other variables.Conclusion. Silent deposition of MSU crystals in patients with asymptomatic hyperuricemia was associated with more severe coronary calcification, which suggests more severe CAD in relation to crystal deposition.Gout is a disease characterized by deposition of monosodium urate (MSU) crystals (1). The hallmark clinical presentation is recurrent acute monoarthritis separated by long asymptomatic periods; in some cases, prominent accumulations of MSU crystals known as tophi develop. MSU crystals form and deposit when serum uric acid levels in body fluids are above the solubility limit (;7 mg/dl); this cutoff level has been used to define asymptomatic hyperuricemia in the absence of gouty manifestations, although other definitions have been used depending on the approach of the investiga-

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Section: Discussioncontrasting

confidence: 66%

Silent Monosodium Urate Crystal Deposits Are Associated With Severe Coronary Calcification in Asymptomatic Hyperuricemia: An Exploratory Study

Andrés

Quintanilla

Sivera

et al. 2016

Arthritis & Rheumatology

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“…In the previous EULAR recommendations,13 the first two recommendations stated that in the absence of SF analysis, a clinical diagnosis of gout can be reasonably made for typical presentations, particularly when patients present with podagra, that is, a gout flare at the first MTP joint. Since then, the predictive values (individually and combined) of typical clinical features of gout have been determined22–25 and new classification criteria and algorithms based solely on clinical signs and symptoms have been produced, in patients experiencing26 27 or not experiencing acute arthritis 28–30. Their external validity when compared with SF analysis has also been determined.…”

Section: Recommendationsmentioning

confidence: 99%

2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout

et al. 2019

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Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.

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“…This need, in combination with the development of new therapeutic options, has focused attention on new imaging modalities and their potential to improve diagnosis and disease management, possibly rendering joint puncture unnecessary. A recent systematic literature review, as part of the 3e Initiative on Diagnosis and Management of Gout, highlighted dual energy computerized tomography (DECT) and ultrasound (US) as promising imaging tools that have shown markedly better performance than clinical findings, although further testing is warranted 6 . In comparison to DECT, US appears to be more feasible because it is patient-friendly, safe and non-invasive, free of ionizing radiation, allows multiple target assessment in real time, and may aid the aspiration process for relevant material for microscopy 7 .…”

mentioning

confidence: 99%

Ultrasound as an Outcome Measure in Gout. A Validation Process by the OMERACT Ultrasound Working Group

Terslev¹,

Gutiérrez²,

Schmidt³

et al. 2015

J Rheumatol

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Diagnostic Value of Clinical, Laboratory, and Imaging Findings in Patients with a Clinical Suspicion of Gout: A Systematic Literature Review

Abstract: Individual clinical features show low diagnostic utility, with the exception of tophi and response to colchicine. Some US and DECT findings show better performance than most clinical features.

Cited by 21 publications

References 27 publications

Silent Monosodium Urate Crystal Deposits Are Associated With Severe Coronary Calcification in Asymptomatic Hyperuricemia: An Exploratory Study

Silent Monosodium Urate Crystal Deposits Are Associated With Severe Coronary Calcification in Asymptomatic Hyperuricemia: An Exploratory Study

2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout

Ultrasound as an Outcome Measure in Gout. A Validation Process by the OMERACT Ultrasound Working Group

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