2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout
Por:
Richette, P, Doherty, M, Pascual E, Barskova, V, Becce, F, Castaneda, J, Coyfish, M, Guillo, S, Jansen, T, Janssens, H, Liote, F, Mallen, C, Nuki, G, Perez-Ruiz, F, Pimentao, J, Punzi, L, Pywell, A, So, A, Tausche, A, Uhlig, T, Zavada, J, Zhang, W, Tubach, F and Bardin, T
Publicada:
1 ene 2020
Ahead of Print:
5 jun 2019
Resumen:
Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.
Filiaciones:
Richette, P:
Service de Rhumatologie, Hopital Lariboisiere Centre Viggo Petersen, Paris, France
Inserm UMR1132 Bioscar, Universite Paris Diderot UFR de Medecine, Paris, France
Doherty, M:
Academic Rheumatology, University of Nottingham, Nottingham, UK
Pascual E:
Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
Barskova, V:
Institute of Rheumatology, RAMS, Moscow, Russian
Becce, F:
Radiology, Lausanne University Hospital, Lausanne, Switzerland
Castaneda, J:
AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), INSERM, UMR 1123 ECEVE, CIC-1421, Paris, France, Paris, France
Coyfish, M:
Nottingham, UK
Guillo, S:
Département d'Epidémiologie et Recherche Clinique, Paris, France
Jansen, T:
Rheumatology, VieCuri, Venlo, Netherlands
Janssens, H:
Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
Liote, F:
Department of Rhumatologie, Hôpital Lariboisière, Paris, France
INSERM UMR-1132 and Université Paris Diderot, Paris, France
Mallen, C:
Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
Nuki, G:
Centre Molecular Medicine, University of Edinburgh, Edinburgh, Scotland, UK
Perez-Ruiz, F:
Servicio de Reumatologia, Hospital de Cruces, Baracaldo, Spain
Pimentao, J:
Rheumatology Unit, Clínica Coração de Jesus, Lisbon, Portugal
Punzi, L:
Department of Medicine, University of Padua, Padua, Italy
Pywell, A:
Nottingham, UK
So, A:
Musculoskeletal Medicine, Service de RMR, Lausanne, Switzerland
Tausche, A:
Department of Internal Medicine, Section of Rheumatology, University Clinic Carl Gustav Carus, Dresden, Saxonia, Germany
Uhlig, T:
Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
Zavada, J:
Institute of Rheumatology, Prague, Czech Republic, Czech Republic
Zhang, W:
Academic Rheumatology, Nottingham University, Nottingham, UK
Tubach, F:
Biostatistics and epidemiology, APHP, Hopital Pitié Salpetrière, Paris, France
Bardin, T:
Rheumatology, Assistance Publique - Hopitaux de Paris, Paris, France
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