Diagnosis of chronic gout: evaluating the american college of rheumatology proposal, European league against rheumatism recommendations, and clinical judgment.
OBJECTIVE
Observation of monosodium urate (MSU) crystal is the gold standard for diagnosis of gout, but is rarely performed in daily clinical practice, and diagnosis is based on clinical judgment. Our aim was to identify clinical and paraclinical data included in the European League Against Rheumatism recommendations (EULARr) and American College of Rheumatology proposed criteria (ACRp) for diagnosis of gout in patients with chronic gout according to their attending rheumatologists.


METHODS
This cross-sectional and multicenter study included consecutive patients from outpatient clinics with a diagnosis of gout by their attending rheumatologists according to their expertise. The frequency of each item from the ACRp and EULARr was determined. Possible combinations of the items that were frequent, clinically relevant, and simple to evaluate in daily practice were determined.


RESULTS
We studied 549 patients (96% men), mean age 50 +/- 14 years. Analysis of MSU crystals was performed in 15%. We selected 7 clinical criteria and 1 laboratory measure because of their frequency, importance, and simplicity to obtain: current or past history of: > 1 attack of acute arthritis (93%); mono or oligoarthritis attacks (74%); rapid progression of pain and swelling (< 24 hours; 74%); podagra (70%); erythema (56%); unilateral tarsitis (33%); tophi (52%); and hyperuricemia (93%). The chronic gout diagnosis (CGD) proposal comprised >or= 4/8 of these; 88% of patients had the criteria of the CGD proposal while 75% had 6/11 ACRp criteria (p = 0.001). When analysis of MSU crystals was added, 90.1% (CGD) and 83.9% (ACRp) met the criteria (p = 0.004).


CONCLUSIONS
Current or past history of >or= 4/8 CGD parameters is highly suggestive of chronic gout.
Peláez-Ballestas
Ingris
I
Servicio de Reumatología, Hospital General de México, 06726 México City, Mexico.
Hernández Cuevas
Claudia
C
Burgos-Vargas
Rubén
R
Hernández Roque
Lizandra
L
Terán
Leobardo
L
Espinoza
Jesús
J
Esquivel-Valerio
Jorge A
JA
Goycochea-Robles
María Victoria
MV
Aceves
Francisco J
FJ
Bernard
Ana Guilaisne
AG
Ventura
Lucio
L
Shumsky
Clara
C
Hernández Garduño
Adolfo
A
Vázquez-Mellado
Janitzia
J
D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003460:Crystallization; D005062:European Union; D005260:Female; D006073:Gout / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism; D017408:Guidelines as Topic; D006801:Humans; D033461:Hyperuricemia / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D012219:Rheumatology / Q000379:methods* / Q000592:standards; D014033:Toe Joint / Q000503:physiopathology; D014527:Uric Acid / Q000302:isolation & purification
D014527:Uric Acid