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Tophaceous Gout
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Synonyms and Keywords: Urate crystal arthropathy; uric acid crystal deposition in joint; gouty arthritis; podagra

Overview

Historical Perspective

Pathophysiology

Differentiating Gout from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | X Ray | Ultrasonograpy |CT | MRI


Accuracy of diagnostic criteria for gout among patients who had synovial fluid analysis [1]
  Criteria Sensitivity Specificity
ARA (ACR) 6 of 12 criteria 70% 79%
Rome 2 of 4 criteria:
• Painful joint swelling, abrupt onset, Clearing in 1-2 weeks initially
• Serum uric acid: >7 in males; >6 in females
• Presence of tophi
• Urate crystals in synovial fluid or tissues
70% 83%
New York 2 of 5 criteria:
• 2 attacks of painful limb joint swelling
• Abrupt onset and remission in 1—2 weeks initially
• First MTP attack
• Presence of a tophus
• Response to colchicine-major reduction in inflammation within 48 h
67% 89%

Several sets of diagnostic criteria exit (see table).[1]

The serum uric acid level during an attack of gout[2][3]
  Sensitivity Specificity
> 5.88 mg/dl[2] 95% 53%
≥ 6 mg/dl[3] 86%  ?
≥ 8 mg/dl[3] 68% ?

A clinical prediction rule (link to online version[4]) found that the following predicted urate crystals by aspiration:[2]

  • Male
  • Onset within one day
  • Joint redness
  • First metatarsaophalangeal joint
  • Previous arthritis attack per patient
  • History of hypertension or 1 or more cardiovascular diseases
  • Serum uric acid level > 5.88 mg/dl

However, among patients with high scores, 20% did not have crystals. Only one of 381 patients had bacterial arthritis.

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Case #1

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References

  1. 1.0 1.1 Malik A, Schumacher HR, Dinnella JE, Clayburne GM (2009). "Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis.". J Clin Rheumatol. 15 (1): 22–4. PMID 19125136. doi:10.1097/RHU.0b013e3181945b79. 
  2. 2.0 2.1 2.2 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 (13): 1120–6. PMID 20625017. doi:10.1001/archinternmed.2010.196. 
  3. 3.0 3.1 3.2 Schlesinger N, Norquist JM, Watson DJ (2009). "Serum urate during acute gout". J. Rheumatol. 36 (6): 1287–9. PMID 19369457. doi:10.3899/jrheum.080938.  Unknown parameter |month= ignored (help)
  4. Sylvester JE, Leggit JC (2016). "Diagnostic Tool for Gout Without Need for Joint Fluid Aspiration.". Am Fam Physician. 93 (4): 256–8. PMID 26926810. 
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