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External validation of Gout-calculator performance on a cohort of acute arthritis (SYNOLACTATE) sparing distal joints such as hallux and midfoot. A cross-sectional study of 170 patients

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Abstract

Objective

To evaluate the performance of the Gout-calculator in a cohort of consecutive acute arthritis affecting large and intermediate joints (without an attack on hallux or midfoot joints).

Methods

A retrospective study. Gout-calculator data were collected in medical records of patients included in the prospective consecutive cohort of acute arthritis called SYNOLACTATE. The diagnosis of gout was defined by the presence of sodium urate crystals in synovial fluid. The diagnostic performance of the Gout-calculator was studied by performing an ROC curve with the calculation of its AUC (95% CI) as well as the calculation of Sensitivity (Se), Specificity (Sp), and positive likelihood ratio (LR+).

Results

170 patients with acute arthritis were included. Variables associated with the diagnosis of gout were as follows: serum uric acid > 350 μmol/L (OR 5.52 (2.52–12.1), p < 0.001), joint redness (OR 5.08 (1.85–14.0), p = 0.001), previous patient-reported arthritis attack (OR 4.04 (1.92–8.49), p < 0.001), male (OR 3.00 (1.17–7.69), p = 0.02), hypertension or cardiovascular disease (OR 2.33 (1.07–5.06), p = 0.03). The median (IQR) of Gout-calculator was significantly higher in gouty arthritis (7.0 [5.5–8.1]) than in associated-CPP acute arthritis (4.0 [2.0–5.8]), septic arthritis (3.0 [2.0–5.1]), or others arthritis (3.5 [2.0–5.5]). The AUC was 0.833 (0.768–0.897) with for the threshold ≥ 8, a Se at 27.5% (0.161–0.428), Sp 97.7% (0.934–0.992), and LR+ 11.9 (3.5-40).

Conclusion

Despite diagnostic performances close to those published, the use of the Gout-calculator is not sufficient for the diagnosis of gout or to exclude the differential diagnosis of septic arthritis in the SYNOLACTATE cohort.

Key Points:

• For a Gout-calculator threshold of ≤ 4, Sensitivity is 92.5%, Specificity 50.8% and LR− 0.15 to the gout diagnosis.

• For a Gout-calculator threshold of > = 8, Sensitivity is 27.5%, Specificity 97.7% and LR+ 11.9 to the gout diagnosis.

• In a population of acute arthritis affecting large joints, Gout-calculator is not sufficient to discriminate between gouty arthritis and septic arthritis.

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Data availability

The cohort database is supervised by GC and OB. Data are available upon reasonable request. All data relevant to the study are included in the article.

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Acknowledgments

All authors would like to thank the patients who participated in this study.

Author information

Authors and Affiliations

  1. Department of Rheumatology, Rennes University Hospital, Hôpital Sud, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France

    F. Robin, O. Berthoud, J. D. Albert, S. Cadiou & P. Guggenbuhl

  2. UMR INSERM U 1241, University of Rennes, Rennes, France

    F. Robin, J. D. Albert, A. Gougeon-Jolivet, C. Bendavid & P. Guggenbuhl

  3. Bacteriology Laboratory, Rennes University Hospital - Pontchaillou, 2 Rue Henri Le Guilloux, 35000, Rennes, France

    A. Gougeon-Jolivet

  4. Department of Biochemistry, Rennes University Hospital - Pontchaillou, 2 Rue Henri Le Guilloux, 35000, Rennes, France

    C. Bendavid

  5. Rheumatology Department, Groupe Territorial Hospitalier Rance-Emeraude Dinan Hospital, 74 boulevard Chateaubriand, 22100, Dinan, France

    Guillaume Coiffier

Authors
  1. F. Robin
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  2. O. Berthoud
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  3. J. D. Albert
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  4. S. Cadiou
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  6. C. Bendavid
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  7. P. Guggenbuhl
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  8. Guillaume Coiffier
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Contributions

GC, OB, AJD, FR, and SC included patients, conducted inclusion visits, performed joint puncture, analyzed results and statistics, and wrote the manuscript; GJA performed microbiologic analysis on synovial fluid, analyzed results and statistics, and wrote the manuscript; BC performed biochemist analysis on synovial fluid, analyzed results and statistics, and wrote the manuscript; PG supervised the progress of the study, analyzed results and statistics, and wrote the manuscript.

Corresponding author

Correspondence to Guillaume Coiffier.

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Ethical approval information

All patients were informed of the objectives and procedures of the study and gave their consent. The study was approved by the ethics committee of Rennes university hospital (Avis no. 16.96, September 2016).

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Robin, F., Berthoud, O., Albert, J.D. et al. External validation of Gout-calculator performance on a cohort of acute arthritis (SYNOLACTATE) sparing distal joints such as hallux and midfoot. A cross-sectional study of 170 patients. Clin Rheumatol 40, 1983–1988 (2021). https://doi.org/10.1007/s10067-020-05382-z

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