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Título: "2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative"

Autores: Tuhina Neogi, Tim L Th A Jansen, Nicola Dalbeth, Jaap Fransen, H Ralph Schumacher, Dianne Berendsen, Melanie Brown, Hyon Choi, N Lawrence Edwards, Hein J E M Janssens, Frédéric Lioté, Raymond P Naden, George Nuki, Alexis Ogdie, Fernando Perez-Ruiz, Kenneth Saag, Jasvinder A Singh, John S Sundy, Anne-Kathrin Tausche, Janitzia Vaquez-Mellado, Steven A Yarows, William J Taylor.

Neogi T, Jansen TLTA, Dalbeth N, et al.
Ann Rheum Dis 2015; 74 :1789 – 1798.

ABSTRACT

Objective
Existing criteria for the classification of gout have suboptimal sensitivity and/or speci fi city, 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 multi-criterion 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 one episode of peripheral joint or bursal swelling, pain, or tenderness. The presence of MSU crystals in a symptomatic joint/ bursa (ie, synovial fluid) or in a tophus is a suf fi cient 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 CT, radiographic gout-related erosion). The sensitivity and speci fi city of the criteria are high (92% and 89%, respectively).

Conclusions
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.

 
 
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