Janssens et al developed a diagnostic rule for acute gouty arthritis. This can allow a primary care provider to diagnose gouty arthritis without joint fluid analysis. The authors are from Radboud University Nijmegen and Rijnstate Hospital Arhem in The Netherlands.
Patient selection: adult with monoarthritis
Parameters:
(1) gender
(2) previous report by the patient of an arthritis attack
(3) involvement of first toe metatarsophalangeal (MTP1) joint
(4) history of hypertension and/or cardiovascular disease
(5) beer consumption
(6) serum uric acid concentration in mg/dL
(7) erythrocyte sedimentation rate (ESR) in mm/h
|
Parameter |
Finding |
Points |
|
gender |
male |
0.92 |
|
|
female |
0 |
|
previous arthritis attack |
no |
0 |
|
|
yes |
1.02 |
|
involvement of MTP1 |
no |
0 |
|
|
yes |
1.83 |
|
history of hypertension and/or cardiovascular disease |
no |
0 |
|
|
yes |
1.01 |
|
beer consumption |
no |
0 |
|
|
yes |
1.15 |
|
serum uric acid |
<= 5.88 mg/dL |
0 |
|
|
> 5.88 mg/dL |
2.44 |
|
ESR |
ESR > 20 AND male |
0.68 |
|
|
ESR > 30 AND female |
0.68 |
|
|
neither |
0 |
where:
• Wine consumption reduced the risk of gout.
X =
= SUM(points for all 7 parameters) - 4.66
probability =
= 1 / (1 + EXP((-1) * X)
Performance:
• The area under the ROC curve was 0.87.
• The presence of a tophus with uric acid crystals is still the gold standard for diagnosis.
Purpose: To evaluate an adult with monoarthritis using the diagnostic rule of Janssens et al.
Specialty: Surgery, orthopedic
Objective: criteria for diagnosis
ICD-10: M10, M14.0,
