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An investigation of the independent risk factors that differentiate gout from pseudogout in patients with crystal-induced acute arthritis: a cross-sectional study

  • Observational Research
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Abstract

Objectives

To identify independent risk factors that differentiate gout from pseudogout in patients that present with crystal-induced acute arthritis.

Methods

This cross-sectional study was conducted at Siriraj Hospital (Bangkok, Thailand) during the 25 May 2014–28 November 2014 study period. Patients who presented with crystal-induced acute arthritis were eligible for inclusion. Diagnosis of gout or pseudogout was made by microscopic visualization and analysis of crystals in synovial fluid. Patients with other causes of acute arthritis were excluded. Patients diagnosed with gout were compared with patients diagnosed with pseudogout and factors with a p value less than 0.05 were included in logistic regression analysis.

Results

A total of 103 patients were included. Gout and pseudogout were established in 59 (56.7%) and 44 (42.3%) patients, respectively. Gout patients were younger than pseudogout patients (66.9 ± 14.5 vs. 78.9 ± 12.0 years; p = 0.0001); had higher BMI (22.9 ± 2.5 vs. 21.0 ± 2.5 kg/m2; p = 0.001); had history of recurrent arthritis (91.5 vs. 9.1%; p = 0.001); had higher prevalence of below-knee arthritis (66.1 vs. 31.8%; p = 0.001); had less periarticular soft tissue swelling (57.6 vs. 81.8%; p = 0.01); and had hyperuricemia (8.0 ± 2.5 vs. 5.6 ± 2.7; p = 0.001). In adjusted multivariate analysis, hyperuricemia during acute arthritis/gouty attack characterized gout (OR 2.08, 95% CI 1.2–3.6), while monoarticular attack (OR 4.12, 95% CI 1.3–13.0) and periarticular soft tissue swelling (OR 4.03, 95% CI 1.1–14.9) were indications for pseudogout.

Conclusions

The independent risk factors were found to differentiate gout from pseudogout: Gout: hyperuricemia during gouty attack; Pseudogout: monoarticular attack and periarticular soft tissue swelling.

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References

  1. Ng X, Low AH, Chew LC, Chong YY, Fong KY, Lui NL et al (2013) Disease patterns of rheumatology outpatients seen in a tertiary hospital serving a multi-ethnic, urban Asian population in Singapore. Int J Rheum Dis 16:273–278

    Article  PubMed  Google Scholar 

  2. Lubart E, Leibovitz A, Shapir V, Segal R (2014) On-spot rheumatology consultations in a multilevel geriatric hospital. Isr Med Assoc J 16, 33–36

    PubMed  Google Scholar 

  3. Malemba JJ, Mbuyi-Muamba JM (2008) Clinical and epidemiological features of rheumatic diseases in patients attending the university hospital in Kinshasa. Clin Rheumatol 27:47–54

    Article  CAS  PubMed  Google Scholar 

  4. Schumacher HR (1996) Crystal-induced arthritis: an overview. Am J Med 100(2a):46s–52s

    Article  CAS  PubMed  Google Scholar 

  5. Burns CM, Wortmann RL (2013) Clinical feature and treatment of gout. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O’Dell JR (eds) Kelly’s textbook of rheumatology. WB Saunders, Philadelphia, pp 1554–1575

    Chapter  Google Scholar 

  6. Edwards NL (2011) Clinical gout. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (eds) Rheumatology. Mosby Elsevier, Philadelphia, pp 1859–1865

    Chapter  Google Scholar 

  7. Richette P, Bardin T, Doherty M (2009) An update on the epidemiology of calcium pyrophosphate dihydrate crystal deposition disease. Rheumatology 48:711–715

    Article  PubMed  Google Scholar 

  8. Louthrenoo W, Sukitawut W (1999) Calcium pyrophosphate dihydrate crystal deposition: a clinical and laboratory analysis of 91 Thai patients. J Med Assoc Thai 82:569–576

    CAS  PubMed  Google Scholar 

  9. American College of Chest Physicians/ Society of Critical Care Medicine Consensus Conference (1992) definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874

    Article  Google Scholar 

  10. McKee PA, Castelli WP, McNamara PM, Kannel WB (1971) The natural history of congestive heart failure: the Framingham study. N Engl J Med 285:1441–1446

    Article  CAS  PubMed  Google Scholar 

  11. Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120:c179–84

    PubMed  Google Scholar 

  12. Thygesen K, Alpert JS, White HD, Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction (2007) Universal definition of myocardial infarction. Eur Heart J 28:2525–2538

    Article  PubMed  Google Scholar 

  13. Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yü TF (1977) Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 20:895–900

    Article  CAS  PubMed  Google Scholar 

  14. Schlesinger N, Norquist JM, Watson DJ (2009) Serum urate during acute gout. J Rheumatol 36:1287–1289

    Article  CAS  PubMed  Google Scholar 

  15. Bădulescu M, Macovei L, Rezuş E (2014) Acute gout attack with normal serum uric acid levels. Rev Med Chir Soc Med Nat Iasi 118:942–945

    PubMed  Google Scholar 

  16. Urano W, Yamanaka H, Tsutani H, Nakajima H, Matsuda Y, Taniguchi A et al (2002) The inflammatory process in the mechanism of decreased serum uric acid concentrations during acute gouty arthritis. J Rheumatol 29:1950–1953

    CAS  PubMed  Google Scholar 

  17. Doherty M, Dieppe PA (1981) Acute pseudogout: “crystal shedding” or acute crystallization? Arthritis Rheum 24:954–957

    Article  CAS  PubMed  Google Scholar 

  18. Schlapbach P, Pfluger D, Gerber NJ (1992) Identification of crystals in synovial fluid: joint-specific identification rate and correlation with clinical preliminary diagnosis. Schweiz Med Wochenschr 122:969–974

    CAS  PubMed  Google Scholar 

  19. Joseph J, McGrath H (1995) Gout or ‘pseudogout’: how to differentiate crystal-induced arthropathies. Geriatrics 50:33–39

    CAS  PubMed  Google Scholar 

  20. Löffler C, Sattler H, Peters L, Löffler U, Uppenkamp M, Bergner R (2015) Distinguishing gouty arthritis from calcium pyrophosphate disease and other arthritides. J Rheumatol 42:513–520

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors gratefully acknowledge the patients who participated in this study and Mr. Kevin P. Jones for assistance with medical research manuscript editing.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand

    Chayawee Muangchan & Thitirat Bhurihirun

Authors
  1. Chayawee Muangchan
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  2. Thitirat Bhurihirun
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Contributions

Study conception and design: MC. Acquisition of data: MC, BT. Analysis and interpretation of data: MC, BT. Drafting of manuscript: MC, BT. Critical revision: MC, BT.

Corresponding author

Correspondence to Chayawee Muangchan.

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Funding

This study was funded by a grant from the Thai Rheumatism Association (TRA).

Conflict of interest

The authors hereby declare no personal or professional conflicts of interest regarding any aspect of this study.

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Muangchan, C., Bhurihirun, T. An investigation of the independent risk factors that differentiate gout from pseudogout in patients with crystal-induced acute arthritis: a cross-sectional study. Rheumatol Int 38, 89–95 (2018). https://doi.org/10.1007/s00296-017-3891-2

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  • DOI: https://doi.org/10.1007/s00296-017-3891-2

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