title: Application of a Novel Diagnostic Rule in the Differential Diagnosis between Acute Gouty Arthritis and Septic Arthritis.
abstract: Septic arthritis and gout are major diseases that should be suspected in patients with acute monoarthritis. These two diseases are clinically similar and often indistinguishable without the help of synovial fluid analysis. Recently, a novel diagnostic rule for gout without synovial fluid analysis was developed and showed relevant performances. This study aimed to determine whether this diagnostic rule could perform well in distinguishing gout from septic arthritis. The diagnostic rule comprises 7 clinical and laboratory variables, each of which is given a specified score. The probability of gout is classified into 3 groups according to the sum of the scores: high (≥ 8), intermediate (> 4 to < 8) and low probability (≤ 4). In this retrospective study, we applied this diagnostic rule to 136 patients who presented as acute monoarthritis and were subsequently diagnosed as acute gout (n = 82) and septic arthritis (n = 54) based on synovial fluid analysis. The mean sum of scores of acute gout patients was significantly higher than that of those with septic arthritis (8.6 ± 0.2 vs. 3.6 ± 0.32, P < 0.001). Patients with acute gout had significantly more 'high', and less 'low' probabilities compared to those with septic arthritis (Eta[η]: 0.776). The prevalence of acute gouty arthritis, as confirmed by the presence of monosodium crystal, was 95.5% (61/64), 57.5% (19/33), and 5.1% (2/39) in high, intermediate and low probability group, respectively. The recently introduced diagnostic rule properly discriminates acute gout from septic arthritis. It may help physicians diagnose gout in cases difficult to be differentiated from septic arthritis.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Kwang-Hoon
authors.identifier: 0000-0002-9506-9072
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
authors.forename: Sang-Tae
authors.identifier: 0000-0002-2074-1733
authors.initials: ST
authors.lastname: Choi
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Soo-Kyung
authors.identifier: 0000-0002-3979-4560
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors.forename: Joo-Hyun
authors.identifier: 0000-0003-4549-6284
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors.forename: Bo-Young
authors.identifier: 0000-0002-9635-4799
authors.initials: BY
authors.lastname: Yoon
mesh_terms: D000208:Acute Disease; D000465:Algorithms; D015210:Arthritis, Gouty / Q000175:diagnosis*; D001170:Arthritis, Infectious / Q000175:diagnosis*; D003627:Data Interpretation, Statistical; D003661:Decision Support Techniques; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Arthritis, Infectious; Diagnosis, Differential; Diagnostic Test; Gout