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Ann Rheum Dis. 2016 Jan;75(1):178-82. doi: 10.1136/annrheumdis-2014-206364. Epub 2014 Oct 28.

Performance of classification criteria for gout in early and established disease.

Author information

1
Department of Medicine, University of Otago, Wellington, New Zealand.
2
Department of Rheumatology, Radboud University Medical Centre, Nijmegen, Netherlands.
3
Department of Medicine, University of Auckland, Auckland, New Zealand.
4
Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
5
VA Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
6
Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
7
Servicio de Reumatología, Hospital General de México, México City, México.
8
Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia.
9
School of Medicine and Medical Science, University College Dublin, Dublin, Ireland Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland.
10
Department of Medicine, University of Otago, Christchurch, Canterbury, New Zealand.
11
Rheumatology Division, Hospital Universitario Cruces & BioCruces Health Research Institute, Vizcaya, Spain.
12
Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain.
13
University of Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France INSERM, UMR 1132, Hôpital Lariboisière, Paris, France Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, 2, Rue Ambroise Paré, Paris, France.
14
Department of Rheumatology, Amsterdam Rheumatology Immunology Center (ARC), Westfries Gasthuis, Hoorn, the Netherlands.
15
Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy.
16
Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
17
Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan, ROC.
18
Taichung Veterans' General Hospital, Taichung, Taiwan, ROC.
19
Division of Rheumatology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany.
20
Division of Rheumatology, Department of Internal Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.
21
Department of Rheumatology, Rijnstate Hospital, Arnhem, the Netherlands.
22
School of Medicine, China Medical University, Taichung, Taiwan, ROC Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, ROC.
23
Centre of Rheumatology and Spine Disorders, Copenhagen University Hospital Glostrup, Glostrup, Denmark.
24
Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy.
25
National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Vinderen, Oslo, Norway.

Abstract

OBJECTIVES:

To compare the sensitivity and specificity of different classification criteria for gout in early and established disease.

METHODS:

This was a cross-sectional study of consecutive rheumatology clinic patients with joint swelling in which gout was defined by presence or absence of monosodium urate crystals as observed by a certified examiner at presentation. Early disease was defined as patient-reported onset of symptoms of 2 years or less.

RESULTS:

Data from 983 patients were collected and gout was present in 509 (52%). Early disease was present in 144 gout cases and 228 non-cases. Sensitivity across criteria was better in established disease (95.3% vs 84.1%, p<0.001) and specificity was better in early disease (79.9% vs 52.5%, p<0.001). The overall best performing clinical criteria were the Rome criteria with sensitivity/specificity in early and established disease of 60.3%/84.4% and 86.4%/63.6%. Criteria not requiring synovial fluid analysis had sensitivity and specificity of less than 80% in early and established disease.

CONCLUSIONS:

Existing classification criteria for gout have sensitivity of over 80% in early and established disease but currently available criteria that do not require synovial fluid analysis have inadequate specificity especially later in the disease. Classification criteria for gout with better specificity are required, although the findings should be cautiously applied to non-rheumatology clinic populations.

KEYWORDS:

Epidemiology; Gout; Synovial fluid

PMID:
25351521
DOI:
10.1136/annrheumdis-2014-206364
[Indexed for MEDLINE]

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