title: Diagnostic value of clinical, laboratory, and imaging findings in patients with a clinical suspicion of gout: a systematic literature review.
abstract: OBJECTIVE
  To analyze the diagnostic utility of clinical, laboratory, and imaging items for gout.
  
  
  METHODS
  A systematic literature search was performed in MEDLINE, EMBASE, and The Cochrane Library; and a manual search of abstracts from the 2010/2011 meetings of the American College of Rheumatology (ACR) and the European League Against Rheumatism, as well as the reference lists of retrieved papers. Studies were included if they evaluated the diagnostic utility of clinical, laboratory, or imaging features or criteria for the diagnosis or classification of gout in adult patients. Two independent reviewers selected papers, extracted the data, and assessed the risk of bias.
  
  
  RESULTS
  Nineteen studies were included in the review; 4 used the identification of monosodium urate (MSU) crystals as the reference standard (RS) and the rest used expert opinion or the ACR preliminary criteria. Most features were evaluated in a single study. Evidence for diagnostic utility, using MSU crystals as RS, of over 50 individual clinical, laboratory, and radiographic features was retrieved. Most items showed a positive likelihood ratio (LR+) < 3, except for the following: response of arthritis to colchicine (LR+ 4.3); presence of tophi on physical examination (LR+ 15.6-30.9); identification of the double-contour sign in ultrasound (US) (LR+ 13.6); and detection of urate deposits by dual-energy computed tomography (DECT) (LR+ 9.5).
  
  
  CONCLUSIONS
  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.
authors.affiliation: From the Department of Rheumatology, Hospital General Universitario de Elda, Elda; Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York City, NY, USA; Department of Rheumatology, University Medical Center, Leiden, the Netherlands; and Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain.F. Sivera, MD, Department of Rheumatology, Hospital General Universtario de Elda; M. Andrés, MD, Sección de Reumatología, Hospital General Universitario de Alicante; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; L. Carmona, MD, PhD, Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela. fransimas@yahoo.es.
authors.forename: Francisca
authors.initials: F
authors.lastname: Sivera
authors.affiliation: From the Department of Rheumatology, Hospital General Universitario de Elda, Elda; Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York City, NY, USA; Department of Rheumatology, University Medical Center, Leiden, the Netherlands; and Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain.F. Sivera, MD, Department of Rheumatology, Hospital General Universtario de Elda; M. Andrés, MD, Sección de Reumatología, Hospital General Universitario de Alicante; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; L. Carmona, MD, PhD, Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela.
authors.forename: Mariano
authors.initials: M
authors.lastname: Andrès
authors.affiliation: From the Department of Rheumatology, Hospital General Universitario de Elda, Elda; Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York City, NY, USA; Department of Rheumatology, University Medical Center, Leiden, the Netherlands; and Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain.F. Sivera, MD, Department of Rheumatology, Hospital General Universtario de Elda; M. Andrés, MD, Sección de Reumatología, Hospital General Universitario de Alicante; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; L. Carmona, MD, PhD, Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela.
authors.forename: Louise
authors.initials: L
authors.lastname: Falzon
authors.affiliation: From the Department of Rheumatology, Hospital General Universitario de Elda, Elda; Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York City, NY, USA; Department of Rheumatology, University Medical Center, Leiden, the Netherlands; and Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain.F. Sivera, MD, Department of Rheumatology, Hospital General Universtario de Elda; M. Andrés, MD, Sección de Reumatología, Hospital General Universitario de Alicante; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; L. Carmona, MD, PhD, Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela.
authors.forename: Désirée M F M
authors.initials: DM
authors.lastname: van der Heijde
authors.affiliation: From the Department of Rheumatology, Hospital General Universitario de Elda, Elda; Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York City, NY, USA; Department of Rheumatology, University Medical Center, Leiden, the Netherlands; and Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela, Madrid, Spain.F. Sivera, MD, Department of Rheumatology, Hospital General Universtario de Elda; M. Andrés, MD, Sección de Reumatología, Hospital General Universitario de Alicante; L. Falzon, PGDipInf, Center for Behavioral Cardiovascular Health, Columbia University Medical Center; D.M. van der Heijde, MD, PhD, Professor of Rheumatology, Rheumatology Department, Leiden University Medical Center; L. Carmona, MD, PhD, Facultad de Ciencias de la Salud, Universidad Camilo Jose Cela.
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
mesh_terms: D001168:Arthritis / Q000000981:diagnostic imaging / Q000188:drug therapy; D003078:Colchicine / Q000627:therapeutic use*; D003952:Diagnostic Imaging; D006073:Gout / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D011859:Radiography; D012680:Sensitivity and Specificity; D014527:Uric Acid / Q000097:blood*
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid; D003078:Colchicine
keywords: DIAGNOSIS; GOUT; HYPERURICEMIA; MSU CRYSTALS; SYSTEMATIC REVIEW