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Comparative Study
. 2016 Jan;75(1):178-82.
doi: 10.1136/annrheumdis-2014-206364. Epub 2014 Oct 28.

Performance of classification criteria for gout in early and established disease

William J Taylor  1 , Jaap Fransen  2 , Nicola Dalbeth  3 , Tuhina Neogi  4 , H Ralph Schumacher  5 , Melanie Brown  1 , Worawit Louthrenoo  6 , Janitzia Vazquez-Mellado  7 , Maxim Eliseev  8 , Geraldine McCarthy  9 , Lisa K Stamp  10 , Fernando Perez-Ruiz  11 , Francisca Sivera  12 , Hang-Korng Ea  13 , Martijn Gerritsen  14 , Carlo Scire  15 , Lorenzo Cavagna  16 , Chingtsai Lin  17 , Yin-Yi Chou  18 , Anne-Kathrin Tausche  19 , Geraldo da Rocha Castelar-Pinheiro  20 , Matthijs Janssen  21 , Jiunn-Horng Chen  22 , Ole Slot  23 , Marco Cimmino  24 , Till Uhlig  25 , Tim L Jansen  2
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Comparative Study

Performance of classification criteria for gout in early and established disease

William J Taylor et al. Ann Rheum Dis. 2016 Jan.

Abstract

Objectives: To compare the sensitivity and specificity of different classification criteria for gout in early and established disease.

Methods: This was a cross-sectional study of consecutive rheumatology clinic patients with joint swelling in which gout was defined by presence or absence of monosodium urate crystals as observed by a certified examiner at presentation. Early disease was defined as patient-reported onset of symptoms of 2 years or less.

Results: Data from 983 patients were collected and gout was present in 509 (52%). Early disease was present in 144 gout cases and 228 non-cases. Sensitivity across criteria was better in established disease (95.3% vs 84.1%, p<0.001) and specificity was better in early disease (79.9% vs 52.5%, p<0.001). The overall best performing clinical criteria were the Rome criteria with sensitivity/specificity in early and established disease of 60.3%/84.4% and 86.4%/63.6%. Criteria not requiring synovial fluid analysis had sensitivity and specificity of less than 80% in early and established disease.

Conclusions: Existing classification criteria for gout have sensitivity of over 80% in early and established disease but currently available criteria that do not require synovial fluid analysis have inadequate specificity especially later in the disease. Classification criteria for gout with better specificity are required, although the findings should be cautiously applied to non-rheumatology clinic populations.

Keywords: Epidemiology; Gout; Synovial fluid.

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