2015 Gout Classification Criteria: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative

Objective Existing criteria for the classification of gout have suboptimal sensitivity and/or specificity, and were developed at a time when advanced imaging was not available. The current effort was undertaken to develop new classification criteria for gout. Methods An international group of invest...

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Published inArthritis & rheumatology (Hoboken, N.J.) Vol. 67; no. 10; pp. 2557 - 2568
Main Authors Neogi, Tuhina, Jansen, Tim L. Th. A., Dalbeth, Nicola, Fransen, Jaap, Schumacher, H. Ralph, Berendsen, Dianne, Brown, Melanie, Choi, Hyon, Edwards, N. Lawrence, Janssens, Hein J. E. M., Lioté, Frédéric, Naden, Raymond P., Nuki, George, Ogdie, Alexis, Perez‐Ruiz, Fernando, Saag, Kenneth, Singh, Jasvinder A., Sundy, John S., Tausche, Anne‐Kathrin, Vaquez‐Mellado, Janitzia, Yarows, Steven A., Taylor, William J.
Format Journal Article Conference Proceeding
LanguageEnglish
Published United States Wiley Subscription Services, Inc 01.10.2015
John Wiley and Sons Inc
Subjects
Arthralgia - diagnosis
Classification
Europe
Gout - classification
Gout - diagnosis
Humans
Medical imaging
Rheumatism
Rheumatology
Special
Synovial Fluid - chemistry
United States
Uric Acid - analysis
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Summary:Objective Existing criteria for the classification of gout have suboptimal sensitivity and/or specificity, and were developed at a time when advanced imaging was not available. The current effort was undertaken to develop new classification criteria for gout. Methods An international group of investigators, supported by the American College of Rheumatology and the European League Against Rheumatism, conducted a systematic review of the literature on advanced imaging of gout, a diagnostic study in which the presence of monosodium urate monohydrate (MSU) crystals in synovial fluid or tophus was the gold standard, a ranking exercise of paper patient cases, and a multicriterion decision analysis exercise. These data formed the basis for developing the classification criteria, which were tested in an independent data set. Results The entry criterion for the new classification criteria requires the occurrence of at least 1 episode of peripheral joint or bursal swelling, pain, or tenderness. The presence of MSU crystals in a symptomatic joint/bursa (i.e., synovial fluid) or in a tophus is a sufficient criterion for classification of the subject as having gout, and does not require further scoring. The domains of the new classification criteria include clinical (pattern of joint/bursa involvement, characteristics and time course of symptomatic episodes), laboratory (serum urate, MSU‐negative synovial fluid aspirate), and imaging (double‐contour sign on ultrasound or urate on dual‐energy computed tomography, radiographic gout‐related erosion). The sensitivity and specificity of the criteria are high (92% and 89%, respectively). Conclusion The new classification criteria, developed using a data‐driven and decision analytic approach, have excellent performance characteristics and incorporate current state‐of‐the‐art evidence regarding gout.
Bibliography:Dr. Choi has received consulting fees, speaking fees, and/or honoraria from AstraZeneca (less than $10,000) and Takeda (more than $10,000).
Dr. Tausche has received consulting fees, speaking fees, and/or honoraria from Berlin‐Chemie Menarini (less than $10,000) and has served as an expert witness on behalf of Ardea Biosciences/AstraZeneca and Novartis.
Annals of the Rheumatic Diseases
Dr. Schumacher has received consulting fees from Novartis, Regeneron, AstraZeneca, and Metabolex (less than $10,000 each).
Dr. Singh has received consulting fees, speaking fees, and/or honoraria from Regeneron, Allergan, and Savient (less than $10,000 each) and Takeda (more than $10,000) and research grants from Savient and Takeda.
Dr. Perez‐Ruiz has received consulting fees, speaking fees, and/or honoraria from AstraZeneca, Menarini, Pfizer, and CymaBay (less than $10,000 each). Dr. Saag has received consulting fees, speaking fees, and/or honoraria from Amgen, AstraZeneca/Ardea, Crealta, and Takeda (less than $10,000 each).
Dr. Jansen has received consulting fees, speaking fees, and/or honoraria from AbbVie, Bristol‐Myers Squibb, Roche, Janssen, Novartis, and Menarini (less than $10,000 each).
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Dr. Taylor has received consulting fees, speaking fees, and/or honoraria from Pfizer, AstraZeneca, AbbVie, and Roche (less than $10,000 each).
Dr. Edwards has received consulting fees, speaking fees, and/or honoraria from AstraZeneca, Crealta, CymaBay, and Takeda (less than $10,000 each).
Dr. Lioté has received consulting fees, speaking fees, and/or honoraria from Novartis, Ardea, AstraZeneca, Ipsen, Menarini, and Savient (less than $10,000 each) and unrestricted academic grants from Novartis, AstraZeneca, Ipsen, Menarini, Savient, and Mayoly‐Spindler.
Dr. Sundy has received consulting fees from Merck, Lilly, AstraZeneca, Metabolex, Novartis, and Navigant (less than $10,000 each).
Dr. Dalbeth has received consulting fees, speaking fees, and/or honoraria from Takeda, Teijin, Menarini, Pfizer, and Fonterra (less than $10,000 each) and AstraZeneca/Ardea (more than $10,000); she holds a patent for Fonterra milk products for gout.
This article is published simultaneously in the October 2015 issue of
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This article is published simultaneously in the October 2015 issue of Annals of the Rheumatic Diseases.
ISSN:2326-5191
2326-5205
DOI:10.1002/art.39254