Diagnosis of Chronic Gout: Evaluating the American College of Rheumatology Proposal, European League Against Rheumatism Recommendations, and Clinical Judgment

2010 ◽  
Vol 37 (8) ◽  
pp. 1743-1748 ◽  
Author(s):  
INGRIS PELÁEZ-BALLESTAS ◽  
CLAUDIA HERNÁNDEZ CUEVAS ◽  
RUBÉN BURGOS-VARGAS ◽  
LIZANDRA HERNÁNDEZ ROQUE ◽  
LEOBARDO TERÁN ◽  
...  
Keyword(s):  
Clinical Judgment ◽  
Past History ◽  
Rapid Progression ◽  
Cross Sectional ◽  
Chronic Gout ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
History Of ◽  
Msu Crystals ◽  
European League

Objective.Observation of monosodium urate (MSU) crystal is the gold standard for diagnosis of gout, but is rarely performed in daily clinical practice, and diagnosis is based on clinical judgment. Our aim was to identify clinical and paraclinical data included in the European League Against Rheumatism recommendations (EULARr) and American College of Rheumatology proposed criteria (ACRp) for diagnosis of gout in patients with chronic gout according to their attending rheumatologists.Methods.This cross-sectional and multicenter study included consecutive patients from outpatient clinics with a diagnosis of gout by their attending rheumatologists according to their expertise. The frequency of each item from the ACRp and EULARr was determined. Possible combinations of the items that were frequent, clinically relevant, and simple to evaluate in daily practice were determined.Results.We studied 549 patients (96% men), mean age 50 ± 14 years. Analysis of MSU crystals was performed in 15%. We selected 7 clinical criteria and 1 laboratory measure because of their frequency, importance, and simplicity to obtain: current or past history of: > 1 attack of acute arthritis (93%); mono or oligoarthritis attacks (74%); rapid progression of pain and swelling (< 24 hours; 74%); podagra (70%); erythema (56%); unilateral tarsitis (33%); tophi (52%); and hyperuricemia (93%). The chronic gout diagnosis (CGD) proposal comprised ≥ 4/8 of these; 88% of patients had the criteria of the CGD proposal while 75% had 6/11 ACRp criteria (p = 0.001). When analysis of MSU crystals was added, 90.1% (CGD) and 83.9% (ACRp) met the criteria (p = 0.004).Conclusion.Current or past history of ≥ 4/8 CGD parameters is highly suggestive of chronic gout.

Applying the ACR/EULAR Systemic Sclerosis Classification Criteria to the Spanish Scleroderma Registry Cohort

2015 ◽  
Vol 42 (12) ◽  
pp. 2327-2331 ◽  
Author(s):  
Luis Sáez-Comet ◽  
Carmen Pilar Simeón-Aznar ◽  
Mercedes Pérez-Conesa ◽  
Carmen Vallejo-Rodríguez ◽  
Carles Tolosa-Vilella ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Multicenter Study ◽  
Classification Criteria ◽  
Raynaud Phenomenon ◽  
Cross Sectional ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
European League

Objective.To compare American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for systemic sclerosis (SSc) with previous American Rheumatology Association (ARA) criteria.Methods.This was a cross-sectional multicenter study comparing sensitivity of both criteria in the cutaneous subsets in the Spanish scleroderma registry (RESCLE) cohort.Results.In 1222 patients with SSc, the most prevalent items were Raynaud phenomenon (95%), skin thickening (91%), and abnormal capillaroscopy (89%). ARA criteria classified as SSc 63.5% of all patients, and 63%, 100%, 11.2%, and 0% in the limited, diffuse, sine, and pre-SSc subsets, respectively. ACR/EULAR criteria classified 87.5% of all patients and 98.5%, 100%, 41.8%, and 15.9% in the same subsets, respectively.Conclusion.ACR/EULAR criteria are more sensitive than ARA criteria, especially in limited, sine, and pre-SSc subsets.

scholarly journals Tophaceous gout of the atlantoaxial joint: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Andrew Benjamin Romero ◽  
Evan Paul Johnson ◽  
John S. Kirkpatrick
Keyword(s):  
Cervical Spine ◽  
Tissue Sample ◽  
Significant Finding ◽  
Atlantoaxial Joint ◽  
Tophaceous Gout ◽  
Case Presentation ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
History Of ◽  
Clinically Significant

Abstract Background To report the occurrence of tophaceous gout in the cervical spine and to review the literature on spinal gout. Case presentation This report details the occurrence of a large and clinically significant finding of tophaceous gout in the atlantoaxial joint of the cervical spine in an 82-year-old Caucasian man with a 40-year history of crystal-proven gout and a 3-month history of new-onset progressive myelopathy. The patient's American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria score was 15.0. Conclusion Spinal gout is more common than previously thought, and it should be considered in patients who present with symptoms of myelopathy. Diagnosis can be made without a tissue sample of the affected joint(s) with tools like the ACR/EULAR criteria and the use of the “diagnostic clinical rule” for determining the likelihood of gout. Early conservative management with neck immobilization and medical management can avoid the need for surgical intervention.

THU0293 PREDICTORS OF LONG-TERM THERAPY WITH GLUCOCORTICOID IN POLYMYALGIA RHEUMATICA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 374-375
Author(s):  
A. Aoki ◽  
H. Kobayashi
Keyword(s):  
Polymyalgia Rheumatica ◽  
Clinical Symptoms ◽  
Therapy Group ◽  
Classification Criteria ◽  
Term Therapy ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Long Term Therapy ◽  
European League

Background:Polymyalgia rheumatica (PMR) is a common inflammatory condition of elderly persons. Clinical symptoms respond to low-dose glucocorticoids (GC), but treatment is often required for several years. 2015 EULAR/ACR recommendations1)recommend considering early introduction of methotrexate (MTX) in addition to GC, particularly in patients at a high risk for relapse and/or prolonged therapy. However, risk factors for prolonged therapy are not clear yet.Objectives:We investigated predictive factors which corresponded to the long-term GC therapy.Methods:This was a retrospective study in a single general hospital in Japan. We reviewed the medical records of the Japanese patients with PMR between April 2011 and January 2020. Diagnosis of PMR was based on Bird’s criteria or 2012 EULAR/ACR Classification Criteria2). All patients were treated with prednisolone (PSL), according to the BSR and BHPR guidelines3), for more than 6 months. Patients treated with MTX and accompanied by the giant cell arteritis were excluded from this study. Relapse was defined as the reappearance of symptoms associated with elevated C-reactive protein (CRP) levels in patients receiving GC that required an increase in GC dose. Remission was defined as the absence of clinical symptoms and normal CRP with discontinuation of GC. We compared the clinical findings, laboratory data at baseline and clinical course between those who achieved remission within 2 years (early-remission group) and those who required GC therapy for more than 2 years (long-therapy group). Comparisons between groups were made using Student’s t-test and chi-square test (IBM SSPE statistics version 26). This study was approved by the ethics committee of Tokyo Medical University (T2019-0079).Results:As of January 2020, 89 patients have been treated with PSL for more than 6 months. 50 patients have achieved a remission, 29 were undergoing treatment, and 10 have transferred to other hospitals or died (Table 1). The median time required for the patients to achieve remission was 16 months (Interquartile Range 12-21). After one-year GC therapy, remission was achieved in 14% (11/77), 66% (41/62) after 2-year, 84% (47/56) after 3-year, and 91.0% (49/54) after 4-years. Forty-one patients, who achieved remission within 2 years, were included in the early-remission group. Twenty-one were included in the long therapy group (Table 1). There were no differences in sex, age at onset, body mass index, clinical features, and serum albumin at diagnosis. Serum CRP of long-therapy group was significantly higher than those of the early-remission group (Table 2). Mean relapse times in the full follow-up times were 0.4 in the early-remission group and 3.1 in the long-therapy group. Multivariate logistic regression analysis showed that history of relapse till 6 months was significant predictors of the long-term GC therapy (odds ratio, 6.48; 95%CI 1.44-29.12).Conclusion:The remission rates of our study are lower than those of the previous reports. We have tapered GC gradually according to the BSR and BHPR guidelines3). However, some patients need the long-term therapy for more than 2 years. We might consider additional MTX therapy in patients who experience a relapse during the first six months.References:[1]Dejaco C, et al. 2015 recommendations for the management of polymyalgia rheumatica: a European League against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2015; 74:1799-1807.[2]Dasgupta B, et al: 2012 provisional classification criteria for polymyalgia rheumatica: a European League against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2012;71: 484-492.[3]Dasgupta, B, et al. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology 2010; 49:186-190.Disclosure of Interests:None declared

European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) SLE classification criteria item performance

2021 ◽  
pp. annrheumdis-2020-219373
Author(s):  
Martin Aringer ◽  
Ralph Brinks ◽  
Thomas Dörner ◽  
David Daikh ◽  
Marta Mosca ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Metabolic Diseases ◽  
Classification Criteria ◽  
Joint Involvement ◽  
Systemic Lupus ◽  
Entry Criterion ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
European League

Background/objectivesThe European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 classification criteria for systemic lupus erythematosus system showed high specificity, while attaining also high sensitivity. We hereby analysed the performance of the individual criteria items and their contribution to the overall performance of the criteria.MethodsWe combined the EULAR/ACR derivation and validation cohorts for a total of 1197 systemic lupus erythematosus (SLE) and n=1074 non-SLE patients with a variety of conditions mimicking SLE, such as other autoimmune diseases, and calculated the sensitivity and specificity for antinuclear antibodies (ANA) and the 23 specific criteria items. We also tested performance omitting the EULAR/ACR criteria attribution rule, which defines that items are only counted if not more likely explained by a cause other than SLE.ResultsPositive ANA, the new entry criterion, was 99.5% sensitive, but only 19.4% specific, against a non-SLE population that included other inflammatory rheumatic, infectious, malignant and metabolic diseases. The specific criteria items were highly variable in sensitivity (from 0.42% for delirium and 1.84% for psychosis to 75.6% for antibodies to double-stranded DNA), but their specificity was uniformly high, with low C3 or C4 (83.0%) and leucopenia <4.000/mm³ (83.8%) at the lowest end. Unexplained fever was 95.3% specific in this cohort. Applying the attribution rule improved specificity, particularly for joint involvement.ConclusionsChanging the position of the highly sensitive, non-specific ANA to an entry criterion and the attribution rule resulted in a specificity of >80% for all items, explaining the higher overall specificity of the criteria set.

scholarly journals Diagnostic, therapeutic and prognostic aspects of uterine synechiae managed by hysteroscopy in the gyanecological endoscopic surgery and human reproductive teaching hospital

2017 ◽  
Vol 7 (1) ◽  
pp. 56
Author(s):  
Etienne Belinga ◽  
Isidore Tompeen ◽  
Claude Cyrille Noa Ndoua ◽  
Junie Metogo Ntsama ◽  
Sandrine Mendibi ◽  
...  
Keyword(s):  
Past History ◽  
Cross Sectional Study ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Qualitative Variables ◽  
Preoperative Diagnostic ◽  
Chi Square Test ◽  
Human Reproductive ◽  
History Of

Background: Uterine synechiae refers to a total or partial union of the inner walls of the uterus resulting from endometrial trauma. It is a cause of reproductive failure. Until now, synechia was not optimally treated and has remained understudied in Cameroon. Objective of present study was to Evaluate the diagnostic, therapeutic and prognostic aspects of uterine synechiae treated by hysteroscopy.Methods: We conducted a descriptive cross-sectional study with an analytical component from January 1st 2015 to July 31st 2017 at Yaounde. All patients diagnosed with uterine synechiae and treated with hysteroscopy were our sample. Sampling was consecutive. The chi-square test was used for the comparison of qualitative variables and Fisher's test for ANOVA variance analysis. The comparison of the averages was made by the Student's test. P-value less than 0.05 was considered as statistically significant.Results: Hysteroscopies were indicated for uterine synechiae in 14.50%. Nulliparous were 56.67%. A history of curettage/aspiration was present in 66.66%. All of the patients had a form of infertility and 83.33% had menstrual disorders. Hysterosalpingography showed a better sensitivity (88%). After hysteroscopic treatment, 63.30% had a complete anatomical restitution. There is a significant correlation between the stage of severity of synechia and anatomical restitution (p=0.008; Spearman correlation coefficient=-0.477).Conclusions: Uterine synechiae represent one-sixth of all indications for hysteroscopy and present clinically as menstrual disorder associated with infertility. A past history of uterine curettage is common. Hysterosalpingography has a better preoperative diagnostic sensitivity. Hysteroscopy allows optimal treatment.

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