Diagnosis of Gout

A Systematic Review in Support of an American College of Physicians Clinical Practice Guideline

Published in: Annals of Internal Medicine, 2016

Posted on RAND.org on November 30, 2016

by Sydne Newberry, John D. Fitzgerald, Aneesa Motala, Marika Booth, Margaret Maglione, Dan Han, Abdul Ahad Tariq, Claire E. O'Hanlon, Roberta M. Shanman, Whitney Dudley, Paul G. Shekelle

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Background

Alternative strategies exist for diagnosing gout that do not rely solely on the documentation of monosodium urate (MSU) crystals.

Purpose

To summarize evidence regarding the accuracy of clinical tests and classification algorithms compared with that of a reference standard of MSU crystals in joint aspirate for diagnosing gout.

Data Sources

Several electronic databases from inception to 29 February 2016.

Study Selection

21 prospective cohort, cross-sectional, and case–control studies including participants with joint inflammation and no previous definitive gout diagnosis who had MSU analysis of joint aspirate.

Data Extraction

Data extraction and risk-of-bias assessment by 2 reviewers independently; overall strength of evidence (SOE) judgment by group.

Data Synthesis

Recently developed algorithms including clinical, laboratory, and imaging criteria demonstrated good sensitivity (up to 88%) and fair to good specificity (up to 96%) for diagnosing gout (moderate SOE). Three studies of dual-energy computed tomography (DECT) showed sensitivities of 85% to 100% and specificities of 83% to 92% for diagnosing gout (low SOE). Six studies of ultrasonography showed sensitivities of 37% to 100% and specificities of 68% to 97%, depending on the ultrasonography signs assessed (pooled sensitivity and specificity for the double contour sign: 74% [95% CI, 52% to 88%] and 88% [CI, 68% to 96%], respectively [low SOE]).

Limitation

Important study heterogeneity and selection bias; scant evidence in primary and urgent care settings and in patients with conditions that may be confused with or occur with gout.

Conclusion

Multidimensional algorithms, which must be validated in primary and urgent care settings, may help clinicians make a provisional diagnosis of gout. Although DECT and ultrasonography also show promise for gout diagnosis, accessibility to these methods may be limited.

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