Monoarticular Arthritis: Which Patients to Treat for Gout?

J. Stephen Bohan, MD, MS, FACP, FACEP


Journal Watch. 2010;30(19) 

In This Article

Abstract and Introduction


A new clinical score supports decision making.


Researchers at an academic rheumatology department in the Netherlands prospectively developed a diagnostic rule for gout using data from 381 consecutive patients with monoarticular arthritis who were referred by family physicians. Within 24 hours of visits to family practitioners, patients underwent joint aspiration, examination of synovial fluid for monosodium urate (MSU) crystals, physical examination, and laboratory testing. Researchers, who were blinded to the family practitioners' diagnoses of gout or nongouty arthritis, analyzed predefined potentially diagnostic variables in logistic regression models; variables that were significantly associated with presence of MSU crystals were weighted and used to develop a clinical prediction model. The best-fit model included seven clinical variables, with a maximum clinical score of 13 (see the table on page 74).

MSU crystals were identified in 216 patients (57%). The prevalence of gout was 2.8% among patients with scores ≤4 and 80.4% among those with scores ≥8. The authors recommend that patients with scores ≥8 should receive therapy for gout and that those with scores between 4 and 8 should undergo joint aspiration and examination for MSU crystals, as well as examination for the remote prospect of infection, depending on history and clinical presentation.


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