Abstract
To evaluate the sensitivity and specificity of the 2015 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) gout classification criteria in Thai patients presenting with acute arthritis in a real-life setting. Data were analyzed on consecutive patients presenting with arthritis of less than 2 weeks duration. Sensitivity and specificity were calculated by using the presence of monosodium urate (MSU) crystals in the synovial fluid or tissue aspirate as gold standard for gout diagnosis. Subgroup analysis was performed in patients with early disease (≤2 years), established disease (>2 years), and those without tophus. Additional analysis also was performed in non-tophaceous gout patients, and patients with acute calcium pyrophosphate dihydrate crystal arthritis were used as controls. One hundred and nine gout and 74 non-gout patients participated in this study. Full ACR/EULAR classification criteria had sensitivity and specificity of 90.2 and 90.0%, respectively; and 90.2 and 85.0%, respectively, when synovial fluid microscopy was excluded. Clinical-only criteria yielded sensitivity and specificity of 79.8 and 87.8%, respectively. The criteria performed well among patients with early and non-tophaceous disease, but had lower specificity in patients with established disease. The variation of serum uric acid level was a major limitation of the classification criteria. The ACR/EULAR classification criteria had high sensitivity and specificity in Thai patients presenting with acute arthritis, even when clinical criteria alone were used.
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References
Kuo CF, Grainge MJ, Zhang W, Doherty M (2015) Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 11:649–662
Kellgren JH, Jeffery MR, Ball JF (1963) The epidemiology of chronic rheumatism. Blackwell, Oxford
Decker JL (1968) Report from the subcommittee on diagnostic criteria for gout. in: Bennett PH, Wood PHN (eds) Population studies of the rheumatic diseases: Proceedings of the third International Symposium New York, June 5–10, 1966, Excerpta Medica Foundation, Amsterdam, pp 385–387
Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yu TF (1977) Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheumatol 20:895–900
Pelaez-Ballestas I, Hernandez Cuevas C, Burgos-Vargas R, Hernandez Roque L, Teran L, Espinoza J et al (2010) Diagnosis of chronic gout: evaluating the american college of rheumatology proposal, European league against rheumatism recommendations, and clinical judgment. J Rheumatol 37:1743–1748
Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M (2010) A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. Arch Intern Med 170:1120–1126
Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, et al (2015) 2015 gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol 67, 2557–2568
Taylor WJ, Fransen J, Dalbeth N, Neogi T, Schumacher HR, Brown M et al (2016) Performance of classification criteria for gout in early and established disease. Ann Rheum Dis 75:178–182
Jatuworapruk K, Lhakum P, Pattamapaspong N, Kasitanon N, Wangkaew S, Louthrenoo W (2016) Performance of the existing classification criteria for gout in Thai patients presenting with acute arthritis. Medicine 95:e2730
Taylor WJ, Fransen J, Jansen TL, Dalbeth N, Schumacher HR, Brown M et al (2015) Study for updated gout classification criteria: identification of features to classify gout. Arthritis Care Res 67:1304–1315
Daniel WW, Cross CL (2013) Estimation in biostatistics: a foundation for analysis in the health sciences, 10th edn. Wiley, Hoboken, p 161–213
McQueen FM, Doyle A, Dalbeth N (2014) Imaging in the crystal arthropathies. Rheum Dis Clin N Am 40:231–249
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The authors wish to thank all participants and Mrs. Antika Wongthanee for her statistical assistance.
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All of the participants gave their written informed consent before data collection. This study was approved by the ethical committee of the Faculty of Medicine, Chiang Mai University. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards. (Approval No. MED-2559-03721).
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Louthrenoo, W., Jatuworapruk, K., Lhakum, P. et al. Performance of the 2015 American College of Rheumatology/European League Against Rheumatism gout classification criteria in Thai patients. Rheumatol Int 37, 705–711 (2017). https://doi.org/10.1007/s00296-017-3708-3
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DOI: https://doi.org/10.1007/s00296-017-3708-3