Preliminary criteria for the classification of the acute arthritis of primary gout

Wallace, Stanley L.; Robinson, Harry; Masi, Alfonse T.; Decker, John L.; McCarty, Daniel J.; Yu, Tzy‐Chyi

doi:10.1002/art.1780200320

Cited by 1,287 publications

(822 citation statements)

References 7 publications

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“…The inclusion criteria were the following: (1) diagnosis of gout proven by presence of MSUr crystals in the synovial fluid [17] or otherwise complying with the American Rheumatism Association criteria [18]; (2) pre-treatment with benzbromarone monotherapy of 100-200 mg/day for at least 2 months with available sUr efficacy results; (3) no relevant liver disease and (4) no relevant renal disease, defined as glomerular filtration rate (GFR) >50 ml min −1 1.73 m −2 .…”

Section: Methodsmentioning

confidence: 99%

Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

et al. 2007

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Section: Methodsmentioning

confidence: 99%

Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

et al. 2007

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“…During this period, a rheumatologist determined the final diagnosis in each subject, with classification in accordance with the accepted American College of Rheumatology (ACR) 1987 criteria for RA (9) or accepted criteria for other rheumatic diseases (10)(11)(12).…”

Section: Figurementioning

confidence: 99%

Bone edema on magnetic resonance imaging is an independent predictor of rheumatoid arthritis development in patients with early undifferentiated arthritis

Duer-Jensen¹,

Hørslev‐Petersen²,

Hetland³

et al. 2011

Arthritis & Rheumatism

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Objective. To study magnetic resonance imaging (MRI) as a tool for early diagnosis of rheumatoid arthritis (RA) in patients with early undifferentiated arthritis (UA).Methods. Patients (n ‫؍‬ 116) without a specific rheumatologic diagnosis, but with >2 tender joints and/or >2 swollen joints among the metacarpophalangeal, proximal interphalangeal, wrist, or metatarsophalangeal (MTP) joints for >6 weeks but <24 months, underwent clinical, biochemical, conventional radiographic, and MRI examinations and were followed up for >12 months for the final diagnosis of RA or non-RA. Based on univariate analyses, clinical, biochemical, and imaging parameters were selected for inclusion as explanatory variables in multiple logistic regression analysis, with development of RA as the dependent variable. A prediction model was developed, and its performance was tested and compared with that of a previous model developed by van der Helm-van Mil et al (the vdHvM model).Results. Of the 116 patients with early UA, 27 (23.3%) developed RA. When the prediction model was applied, which included as explanatory variables presence of hand arthritis, positivity for rheumatoid factor (RF), morning stiffness lasting >1 hour, and the Outcome Measures in Rheumatology Clinical Trials MRI summary score for bone edema in the MTP and wrist joints, the outcome of RA or non-RA was correctly identified in 82% of the patients (sensitivity 81%, specificity 82%). Another cutoff value for the prediction index in the model would allow a higher specificity (98%) and higher accuracy (83%), but lower sensitivity (36%). With the vdHvM model, RA/non-RA was predicted in 60.2% of the population.Conclusion. MRI evidence of bone edema in the MTP and wrist joints is an independent predictor of future RA in patients with early UA. A prediction model that includes the variables clinical hand arthritis, morning stiffness, positivity for RF, and bone edema on MRI in the MTP and wrist joints correctly identified the development or lack of development of RA in 82% of patients.The approach to treatment of rheumatoid arthritis (RA) has changed markedly during the last decades.

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“…All had previously documented MSU crystals in the synovial fluid of 1 jaint, but not necessarily in the knee. All patients, by dqfinition, had met the American Rheumatism Association cdteria for the diagnosis of gout by the documentation of the MSIJ crystals (5).…”

Section: Patientsmentioning

confidence: 99%

Monosodium urate crystals in the knee joints of patients with asymptomatic nontophaceous gout

Lluberas

1986

Arthritis & Rheumatism

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We aspirated synovial fluid from the knees of 50 patients with asymptomatic, nontophaceous gout, in whom synovial fluid monosodium urate (MSU) crystals had previously been documented in the knees or other joints. Fifty-eight percent of these asymptomatic patients had MSU crystals in their knee joints. Serum uric acid levels, serum creatinine levels, volume of synovial fluid aspirated, and cell counts of the aspirated fluid did not differentiate the MSU crystal-positive group from the group without MSU crystals. Clinical factors such as alcohol abuse, coronary heart disease, hypertension, duration of gout, duration of the intercritical period, and drug therapy did not differentiate the 2 groups. Nineteen patients consented to aspiration of their other knee. Seven of these patients (37%) had MSU crystals bilaterally, and 6 patients (32 %) had them unilaterally. The implications of the persistence of MSU crystals (including those in intracellular locations) in many patients, despite normalization of serum uric acid levels, should be determined. Knee joint aspiration is a sensitive method for the demonstration of MSU crystals in asymptomatic patients. The procedure might also be useful in documenting these crystals in patients who have had attacks of arthritis with features consistent with a diagnosis of gout, but in whom MSU crystals have not been documented.Patients with suspected diagnoses of nontophaceous gout, in whom synovial fluid has not been examined for the presence of monosodium urate (MSU) crystals, are often seen by rheumatologists. Most of the rheumatologists consider that a firm diagnosis of gout can be made only by identifying MSU crystals in the synovial fluid of such patients.Previously, MSU crystals have been documented by examination of synovial fluid from both the symptomatic and the asymptomatic first metatarsophalangeal (MTP) joints of patients with nontophaceous gout (1-3). Knee joints are easier to aspirate than are MTP joints, and one would expect that more synovial fluid could be obtained for examination while maintaining the sensitivity of MTP joint aspiration. In one study (4), the synovial fluid from the knees of patients with asymptomatic, clinically tophaceous gout was aspirated, and MSU crystals were documented in 11 of the 13 patients (85%).We attempted to aspirate synovial fluid from the knees of 51 asymptomatic patients with nontophaceous gout, in whom synovial fluid urate crystals had previously been documented in at least 1 joint (not necessarily the knee). We found that 58% of these asymptomatic patients had MSU crystals in their knee joints, and such factors as alcohol abuse, coronary heart disease, and serum uric acid levels did not

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Preliminary criteria for the classification of the acute arthritis of primary gout

Cited by 1,287 publications

References 7 publications

Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients

Bone edema on magnetic resonance imaging is an independent predictor of rheumatoid arthritis development in patients with early undifferentiated arthritis

Monosodium urate crystals in the knee joints of patients with asymptomatic nontophaceous gout

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