Skip to main content
Top

30-05-2014 | Gout | Book Chapter | Article

3. Diagnosis of Gout

Authors: Fernando Perez-Ruiz, Ana Maria Herrero-Beites

Publisher: Springer Healthcare Ltd.

Abstract

A diagnosis of gout must be considered from different points of view, including epidemiologic, physiopathologic, and clinical. In addition, new imaging technologies have recently appeared as potential future diagnostic tools. Although several guidelines and recommendations have been published, neither the British Society for Rheumatology nor the American College of Rheumatology (ACR) guidelines have made any recommendations relating to gout diagnosis. So far, only the European League Against Rheumatism (EULAR) recommendations have taken diagnostic issues into consideration, and they state that monosodium urate crystal (MSUC) identification is the gold standard for diagnosis.

Literature
Jordan KM, Cameron JS, Snaith M, et al; on behalf of the British Society for Rheumatology and British Health Professionals in Rheumatology Standards, Guidelines and Audit Working Group (SGAWG). British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout. Rheumatology (Oxford). 2007;46:1372-1374.
Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012;64:1431-1446.
Khanna D, Khanna PP, Fitzgerald JD, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: Therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken). 2012;64:1447-1461.
Zhang W, Doherty M, Pascual E, et al. EULAR evidence based recommendations for gout. Part I. Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65:1301-1311.
Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yü TF. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. 1977;20:895-900.
Malik A, Schumacher HR, Dinnella JE, Clayburne GM. Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis. J Clin Rheumatol. 2009;15:22-24.
Johnson SR, Goek O-N, Singh-Grewal D, et al. Classification criteria in rheumatic diseases: a review of methodologic properties. Arthritis Rheum. 2007;57:1119-1133.
Janssens HJEM, Fransen J, van de Lisdonk EH, van Riel PLCM, van Weel C, Janssen M. A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. Arch Intern Med. 2010;170:1120-1126.
Janssens HJEM, Janssen M, van de Lisdonk EH, Fransen J, van Riel PLCM, van Weel C. Limited validity of the American College of Rheumatology criteria for classifying patients with gout in primary care. Ann Rheum Dis. 2010;69:1255-1256.
Pérez Ruiz F, Ruiz López J, Herrero Beites AM . Influence of the natural history of disease on a previous diagnosis in patients with gout . Reumatol Clin. 2009;5:248-251.
Leiszler M, Poddar S, Fletcher A. Clinical inquiry. Are serum uric acid levels always elevated in acute gout? J Fam Pract. 2011;60:618-620.
McCarty DJ, Hollander JL. Identification of urate crystals in gouty synovial fluid. Ann Intern Med. 1961;54:452-460.
Pascual E. Persistence of monosodium urate crystals and low-grade inflammation in synovial fluid of patients with untreated gout. Arthritis Rheum. 1991;34:141-145.
Sivera F, Aragon R, Pascual E. First metatarsophalangeal joint aspiration using a 29-gauge needle. Ann Rheum Dis. 2008;67:273-275.
Pascual E, Batlle-Gualda E, Martinez A, Rosas J, Vela P. Synovial fluid analysis for diagnosis of intercritical gout. Ann Intern Med. 1999;131:756-759.
Amer H, Swan A, Dieppe P. The utilization of synovial fluid analysis in the UK. Rheumatology (Oxford). 2001;40:1060-1063.
Graf SW, Buchbinder R, Zochling J, Whittle SL. The accuracy of methods for urate crystal detection in synovial fluid and the effect of sample handling: a systematic review. Clin Rheumatol. 2013;32:225-232.
Lumbreras B, Pascual E, Frasquet J, Gonzalez-Salinas J, Rodriguez E, Hernandez-Aguado I. Analysis for crystals in synovial fluid: training of the analysts results in high consistency. Ann Rheum Dis. 2005;64:612-615.
Shah K, Spear J, Nathanson LA, McCauley J, Edlow JA. Does the presence of crystal arthritis rule out septic arthritis? J Emerg Med. 2007;32:23-26.
Perez-Ruiz F, Dalbeth N, Urresola A, de Miguel E, Schlesinger N. Imaging of gout: findings and utility. Arthritis Res Ther. 2009;11:232.
Wright SA, Filippucci E, McVeigh C, et al. High resolution ultrasonography of the first metatarsal phalangeal joint in gout: a controlled study. Ann Rheum Dis. 2007;66:859-864.
Perez-Ruiz F, Naredo E. Imaging modalities and monitoring measures of gout. Curr Opin Rheumatol. 2007;19:128-133.
Rettenbacher T, Ennemoser S, Weirich H, et al. Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray. Eur J Radiol. 2008;18:621-630.
Dalbeth N, Clark B, McQueen F, Doyle A, Taylor W. Validation of a radiographic damage index in chronic gout. Arthritis Rheum. 2007;57:1067-1073.
Bloch C, Hermann G, Yu T-F. A radiologic reevaluation of gout: a study of 2,000 patients. AJR Am J Roentgenol. 1980;134:781-787.
Howard RG, Pillinger MH, Gyftopoulos S, Thiele RG, Swearingen CJ, Samuels J. Reproducibility of musculoskeletal ultrasound for determining monosodium urate deposition: concordance between readers. Arthritis Care Res (Hoboken). 2011;63:1456-1462.
De Miguel E, Puig JG, Castillo C, Peiteado D, Torres RJ, Martin-Mola E. Diagnosis of gout in patients with asymptomatic hyperuricemia: a pilot ultrasound study. Ann Rheum Dis. 2012;71:157-158.
Pineda C, Amezcua-Guerra LM, Solano C, et al. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Res Ther. 2011;13:R4.
Perez-Ruiz F, Martin I, Canteli B. Ultrasonographic measurement of tophi as an outcome measure for chronic gout. J Rheumatol. 2007;34:1888-1893.
Dalbeth N, Clark B, Gregory K, et al. Mechanisms of bone erosions in gout: a quantitative analysis using plain radiography and computed tomography. Ann Rheum Dis. 2009;68:1290-1295.
Konatalapalli RM, Lumezanu E, Jelinek JS, Murphey MD, Wang H, Weinstein A. Correlates of axial gout: a cross-sectional study. J Rheumatol. 2012;39:1445-1449.
Dalbeth N, Clark B, Gregory K, Gamble GD, Doyle A, McQueen FM. Computed tomography measurement of tophus volume: comparison with physical measurement. Arthritis Rheum. 2007;57:461-465.
Artmann A, Ratzenbock M, Noszian I, Trieb K. Dual energy CT–a new perspective in the diagnosis of gout. Rofo. 2010;182:261-266.
Glazebrook KN, Guimaraes LS, Murthy NS, et al. Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: initial evaluation. Radiology. 2011;261:516-524.
Nicolaou S, Yong-Hing CJ, Galea-Soler S, Hou DJ, Louis L, Munk P. Dual-energy CT as a potential new diagnostic tool in the management of gout in the acute setting. AJR Am J Roentgenol. 2010;194:1072-1078.
McQueen FM, Doyle AJ, Reeves Q, Gamble GD, Dalbeth N. DECT urate deposits: now you see them, now you don›t. Ann Rheum Dis. 2012;72:458-459.
Carter JD, Kedar RP, Anderson SR, et al. An analysis of MRI and ultrasound imaging in patients with gout who have normal plain radiographs. Rheumatology (Oxford). 2009;48:1442-1446.
Narváez JA, Narváez J, Ortega R, De Lama E, Roca Y, Vidal N. Hypointense synovial lesions on T2-weighted images: differential diagnosis with pathologic correlation. AJR Am J Roentgenol. 2003;181:761-769.
Campbell SM. Gout: how presentation, diagnosis, and treatment differ in the elderly. Geriatrics. 1988;43:71-77.
Wolfe F, Cathey MA. The misdiagnosis of gout and hyperuricemia. J Rheumatol. 1991;18:1232-1234.
Perez-Ruiz F, Ruiz Lopez J, Herrero Beites A. Influence of the natural history of disease on a previous diagnosis in patients with gout. Rheumatol Clin. 2009;5:248-251.