Objectives: To analyze the clinical and para-clinical characteristics of patients with gout disease diagnosed by the 2015 EULAR/ACR criteria. Subjects and methods: 31 patients who were diagnosed with gout disease were selected. The study had focused on age, gender, lifestyles, history and current patterns of gout, VAS (Visual Analog Scale) index, plasma uric acid levels, hs-CRP, ESR, ultrasound images of affected joints.
Trang 1STUDY ON CLINICAL AND PARACLINICAL CHARACTERISTICS
OF PATIENTS WITH GOUT DISEASE DIAGNOSED BY THE 2015
EULAR/ACR CRITERIA
Ton Thanh Tung*; Nguyen Ngoc Chau*
SUMMARY
Objectives: To analyze the clinical and para-clinical characteristics of patients with gout disease diagnosed by the 2015 EULAR/ACR criteria Subjects and methods: 31 patients who were diagnosed with gout disease were selected The study had focused on age, gender, lifestyles, history and current patterns of gout, VAS (Visual Analog Scale) index, plasma uric acid levels, hs-CRP, ESR, ultrasound images of affected joints Results: The majority were male (96.8%) The mean age of onset was 47.3 ± 15.2 years, the common age group of onset was from 20 to 40 (41.9%) and commonly with the heavy pain (74.2%) 45.2% of patients were not diagnosed with the first episode of gout lower than previous study’s with statistical significance, the mean time for the definite diagnosis was 4.64 ± 4.4 years Hs-CRP and ESR were two common inflammatory markers 19.4% of patients had normal range of uric acid The double contour lesion accounted for 29.0% There was a moderate positive correlation between the
2015 EULAR/ACR classification criteria for gout scores and the frequency of recurrence attacks
of gout per year (r = 0.46; p < 0.05) Conclusions: The clinical and para-clinical characteristics of patients were almost consistent with the previous studies There was an increase in the rate of patients diagnosed with the first attack of gout The higher score of the EULAR/ACR 2015 classification for gout predicted the higher frequency of recurrence attacks of gout per year
*Keywords: Gout disease; EULAR/ACR 2015; Clinical, paraclinical characteristics
INTRODUCTION
Gout is the most prevalent form of
inflammatory arthritis and is associated
with impaired quality of life There are
many criteria for diagnosing gout disease,
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
Therefore, it is necessary to develop a
new diagnostic tool The 2015 EULAR/ACR
gout classification criteria are developed
using a data-driven and decision analytic
approach, have excellent performance
characteristics and incorporate current modern evidence regarding gout, has higher sensitivity (92%) and higher specificity (89%) than existing criteria In Vietnam, Bennett & Wood classification criterion has been mainly used to diagnose gout disease, the advantages of these criteria are to diagnose based on clinical manifestations, easy to remember and apply but with low sensitivity and specificity
Thus, this study aims: To use new criteria EULAR/ACR 2015 to diagnose gout disease and analyze the collected clinical and paraclinical characteristics of patients
* 103 Military Hospital
Corresponding author: Nguyen Ngoc Chau (chau70@gmail.com)
Date received: 30/06/2017 Date accepted: 06/08/2017
Trang 2SUBJECTS AND METHODS
1 Subjects
* Inclusion criteria:
31 patients including 30 male patients
were treated in the Rheumatology and
Endocrinology Department, 103 Hospital
- Diagnosed with gout disease by the
EULAR/ACR 2015 criteria
- The affected joints were in inflammatory
condition with or without joint effusion
* Exclusion criteria: Suspected bacterial
infection of the joints or other infection
conditions that affect to the evaluation of
the inflammatory investigation results
2 Methods
Cross-sectional, descriptive analysis
* Examination and diagnosis:
- Take a history, age, gender; examine
the affected joints and assess pain levels
of joints (VAS), investigate ESR, hs-CRP,
plasma uric acid concentration, performed
ultrasound the affected joints for detecting
double contour
- Patients with gout disease were
definitely diagnosed by the 2015
EULAR/ACR criteria
* Method of data analysis:
Collected data were analyzed by the
medical statistical method using SPSS
23.0 software
RESULTS AND DISCUSSIONS
1 Clinical and paraclinical
characteristics
* Clinical characteristics:
In total, we identified 31 patients with
gout disease In most cases, the
classification diagnosis was made by the
2015 EULAR/ACR criteria with the total mark more than 8 marks (96.8%) Only one patient with poor clinical findings was diagnosed by detecting urate crystal using polarized light microscopy
In our study, the mean age of onset was rather young (47.3 ± 15.2) The most common age group of onset was 20 - 40 (41.9%) This result was consistent with the result of Hoang Thi Thu Trang (48.8%) It also suggested that the onset
of gout had the tendency of rejuvenation This matched with the tendency of having metabolism diseases in our modern society
The group with overweight and obesity accounted for 41.9%, the mean BMI was 22.4 ± 2.6 This result was also consistent with the result of Hoang Thi Thu Trang studied on Vietnamese (50.1%) In the study of L Annemans (2010), obesity accounted for 27.7% of UK patients [2] According to Lucía Cea Soriano (2011), this rate was 65.99% [6] Recent studies have approved that obesity played an important role in increasing the prevalence
of gout [7]
The heavy pain was the highest ratio (74.2%) and the mean VAS was 73.5 ±
21.2 The result was consistent with the
result of Hoang Thi Thu Trang (68.8%) [1], Pham Thi Minh Nham (79.2%) [5] The result also matched with the intensely painful condition in the pathophysiology of gout
Trang 3Table 1: Inhabit of alcoholic beverage using
Min - Max
p
Alcohol (n = 26)
497.9 ± 110.4
Beer (n = 14)
485.2 ± 90.9
> 0.05
We have known that alcohol and beer had played a big role in increasing the uric acid concentration by the mechanisms of overproduction and reduced excretion uric acid In our study, 100% of patients had the history of using too much alcohol or beer in the long term (83.9% of patients used alcohol, 45.2% of patients used beer) The mean
quantity of alcohol using was 108.3 ± 80.9 g/day, the mean quantity of beer using was
57.3 ± 37.2 g/day However, in our study, alcohol and beer affected to the uric acid concentration equally without statistical significance (p > 0.05)
Table 2: Diagnostic features
Diagnosed with the first episode
Time to be definitely diagnosed with gout
disease (years)
4.64 ± 4.4 years
Diagnosing gout has been a challenge
to the physicians in many cases because
of its various manifestations In our study,
there was still a high ratio of patients who
were not diagnosed with the first episode
(45.2%) The mean time for the definite
diagnosis was 4.64 years In the study of
Hoang Thi Thu Trang, this rate was
higher than ours (68.75%, p < 0.05) This
may be in the study of Hoang Thi Thu
Trang using the Bennet Wood criteria so
the sensitivity and the specificity were
lower With whom the diagnosis was not
established by the first episode, the
shortest time for the definite diagnosis was 1 year, the longest time was 15 years and the mean time was 4.64 ± 4.4 years Our result was shorter than the previous study of Le Thi Vien (2006): 5.98 ± 5.9 years [3] and consistent with the result of Hoang Thi Thu Trang (2.34 ± 5.19 years) Because the patients paid more and more attention to their health, so they visited hospital earlier, at the same time, the level of expertise of general doctors have improved and physicians in primary health care facilities have had a better understanding of gout
Trang 4* Paraclinical characteristics:
80.6% of patients in our study had
elevated uric acid level The mean plasma
uric acid was 503.9 ± 106.4 µmol/L
These results were consistent with
previous studies Hoang Thi Thu Trang
(69.4%; 499.13 ± 143.0 µmol/L) [1], Pham
Hoai Thu (65.3%; 470.2 ± 120.1 µmol/L)
[4] However, 19.4% of patients were
diagnosed acute gout and acute flare of
chronic gout with normal plasma uric acid
concentration This rate was similar to the
result in the study by Hoang Thi Thu
Trang (30.6%) [1] This result showed that
the uric acid concentration was not the
definitive factor to activate the acute flares
of gout This had reported by previous
studies of many authors [8]
Gout is an inflammatory joint disease
So investigating the markers of inflammatory
condition could show us the level of the
inflammation Hs-CRP, ESR and WBC
were the common inflammatory markers
In our study, the elevated level of hs-CRP
was more common (80.6%), followed by the elevated level of ESR (53.6%), WBC was almost normal (54.8%) with the mean WBC 8.39 ± 4.9 These results were consistent with the results of Hoang Thi Thu Trang (93.8%, 73.1% and 55.9%) [1] The results matched with the clinical manifestations of acute gout and acute flares of chronic gout disease The WBC increased without statistically significant difference (42.5% vs 54.8%, p > 0.05), this was absolutely consistent with the infectious inflammatory process of gout disease Synovitis was the most common lesion
on the ultrasound (41.9%), followed by the double contour (29.0%) This result was also similar to a previous study [1] The double contour was a very valuable lesion for diagnosing gout on ultrasound
It indicated the deposition of urate crystals
in the joints and distributed 4 marks into the total 2015 score if positive In our study, we met 2 cases who were detected tophi on ultrasound (6.5%)
Table 3: Plasma uric acid features
Plasma acid uric
(µmol/L)
80.6% of patients had elevated uric acid level, 19.4% of patients had a normal plasma uric acid level The mean plasma uric acid was 503.9 ± 106.4 µmol/L There was no difference of uric acid level between acute gout and acute flare of chronic gout (p > 0.05)
Trang 52 The correlation of the EULAR/ACR 2015 classification for gout scores with the frequency of recurrent attacks per year
Through analyzing the data of 31 patients, we found that there was a moderate positive correlation between the 2015 EULAR/ACR criteria classification for gout scores and the frequency of recurrence attacks of gout per year (r = 0.46; p < 0.05) These result showed that the higher scores of the EULAR/ACR 2015 classification for gout may predict the higher frequency of recurrence of gout No previous studies mentioned about this We considered if there will be a cut-off value of the 2015 EULAR/ACR classification criteria for gout scores that has meaning in prevention
management of gout but needs more studies
y = 0.8842x - 2.8457
0
5
10
15
20
25
30
EULAR/ACR classification for gout marks
Figure 1: Thecorrelation between theEULAR/ACR 2015 classification for gout scores
with the frequency of recurrence attacks of gout per year
CONCLUSION
- The majority were male (96.8%) with
the mean age of onset 47.3 ± 15.2 years,
the common age group of onset was from
20 to 40 (41.9%) and commonly with the
heavy pain (74.2%) 45.2% of patients
were not diagnosed with the first episode
lower than previous study’s with statistical
significance, the mean time for the
definite diagnosis was 4.64 ± 4.4 years
- 19.4% of patients who were diagnosed
acute gout and acute flare of chronic gout,
had normal value Hs-CRP and ESR were
two common inflammatory markers The double contour lesion accounted for 29.0%
- There was a moderate positive correlation between the EULAR/ACR
2015 classification for gout scores and the frequency of recurrence attacks of gout per year (r = 0.46; p < 0.05)
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