J Korean Med Sci.  2015 Jun;30(6):700-704. 10.3346/jkms.2015.30.6.700.

Application of a Novel Diagnostic Rule in the Differential Diagnosis between Acute Gouty Arthritis and Septic Arthritis

• Lee KH
• Choi ST
• Lee SK
• Lee JH
• Yoon BY

• KMID: 2160596
• DOI: http://doi.org/10.3346/jkms.2015.30.6.700

Abstract

Septic arthritis and gout are major diseases that should be suspected in patients with acute monoarthritis. These two diseases are clinically similar and often indistinguishable without the help of synovial fluid analysis. Recently, a novel diagnostic rule for gout without synovial fluid analysis was developed and showed relevant performances. This study aimed to determine whether this diagnostic rule could perform well in distinguishing gout from septic arthritis. The diagnostic rule comprises 7 clinical and laboratory variables, each of which is given a specified score. The probability of gout is classified into 3 groups according to the sum of the scores: high (> or = 8), intermediate (> 4 to < 8) and low probability (< or = 4). In this retrospective study, we applied this diagnostic rule to 136 patients who presented as acute monoarthritis and were subsequently diagnosed as acute gout (n = 82) and septic arthritis (n = 54) based on synovial fluid analysis. The mean sum of scores of acute gout patients was significantly higher than that of those with septic arthritis (8.6 +/- 0.2 vs. 3.6 +/- 0.32, P < 0.001). Patients with acute gout had significantly more 'high', and less 'low' probabilities compared to those with septic arthritis (Eta[eta]: 0.776). The prevalence of acute gouty arthritis, as confirmed by the presence of monosodium crystal, was 95.5% (61/64), 57.5% (19/33), and 5.1% (2/39) in high, intermediate and low probability group, respectively. The recently introduced diagnostic rule properly discriminates acute gout from septic arthritis. It may help physicians diagnose gout in cases difficult to be differentiated from septic arthritis.

Keyword

Gout; Arthritis, Infectious; Diagnosis, Differential; Diagnostic Test

MeSH Terms

Acute Disease
*Algorithms
Arthritis, Gouty/*diagnosis
Arthritis, Infectious/*diagnosis
*Data Interpretation, Statistical
*Decision Support Techniques
Diagnosis, Computer-Assisted/*methods
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Reproducibility of Results
Sensitivity and Specificity

Figure

• 

  Fig. 1 Histogram of the proportion of 3 probability groups in patients with gout and septic arthritis.

Reference

1. Siva C, Velazquez C, Mody A, Brasington R. Diagnosing acute monoarthritis in adults: a practical approach for the family physician. Am Fam Physician. 2003; 68:83–90.

2. Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, 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.

3. Sack K. Monarthritis: differential diagnosis. Am J Med. 1997; 102:30s–34s.

4. Margaretten ME, Kohlwes J, Moore D, Bent S. Does this adult patient have septic arthritis? JAMA. 2007; 297:1478–1488.

5. Mathews CJ, Coakley G. Septic arthritis: current diagnostic and therapeutic algorithm. Curr Opin Rheumatol. 2008; 20:457–462.

6. Dalbeth N, Fransen J, Jansen TL, Neogi T, Schumacher HR, Taylor WJ. New classification criteria for gout: a framework for progress. Rheumatology (Oxford). 2013; 52:1748–1753.

7. 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.

8. 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.

9. Janssens HJ, Janssen M, van de Lisdonk EH, Fransen J, van Riel PL, 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.

10. Peláez-Ballestas I, Hernández Cuevas C, Burgos-Vargas R, Hernández Roque L, Terán L, Espinoza J, Esquivel-Valerio JA, Goycochea-Robles MV, Aceves FJ, Bernard AG, et al. Diagnosis of chronic gout: evaluating the American College of Rheumatology proposal, European League against rheumatism recommendations, and clinical judgment. J Rheumatol. 2010; 37:1743–1748.

11. Kienhorst LB, Janssens HJ, Fransen J, Janssen M. The validation of a diagnostic rule for gout without joint fluid analysis: a prospective study. Rheumatology (Oxford). 2015; 54:609–614.