7 points for clinical diagnosis of gout without joint fluid analysis

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7 points for clinical diagnosis of gout without joint fluid analysis

A systematic review of the diagnosis of acute gout1 was published recently, containing an earlier study from primary care2 with similar findings. 

A clinical score was derived from the odds ratios – highest to lowest correlation:

 Clinical score 

Serum uric acid > 0.36 mmol/l * (5.88 mg/dL) 3.5
First MTP joint involvement 2.5
Male gender 2.0
Previous patient-reported arthritis attack 2.0
Hypertension or ≥ 1 CV diseases 1.5
Joint redness 1.0
Onset within one day 0.5
Maximum score   13.0  

*N.B. uric acid may be low during an acute attack so a blood test 4 or more weeks after an acute attack should be used. 

A score of 8 or more meant gout was confirmed in 80% of cases. In New Zealand, a patient of Māori or Pacific ethnicity would have a higher chance of having gout when presenting with unilateral joint pain, given their very high prevalence of gout.

By age 65 more than 1 in 4 Māori and Pacific men will be on allopurinol for gout.3

References:

  1. Diagnosis of gout: A systematic review in support of an American College of Physicians clinical practice guideline. Ann Intern Med (2017). Click here
  2. A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. Arch Intern Med (2010)Click here
  3. National prevalence of gout derived from administrative health data in Aotearoa New Zealand. Rheumatology (2012.) Click here

    Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

       
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    As published in NZ Doctor 14/03/2018