トマス・ローランドソン作 「Comfort in the Gout」；痛風の快適さ
EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)
W Zhang 1, M Doherty, E Pascual, T Bardin, V Barskova, P Conaghan, J Gerster, J Jacobs, B Leeb, F Lioté, G McCarthy, P Netter, G Nuki, F Perez-Ruiz, A Pignone, J Pimentão, L Punzi, E Roddy, T Uhlig, I Zimmermann-Gòrska, EULAR Standing Committee for International Clinical Studies Including Therapeutics
痛風の診断精度；
突然の発赤・腫脹で2週間以内に改善しなければ、痛風は否定的
発赤がなければ否定的
第1中足趾関節の発作があれば可能性は高い
Table 4 Evidence of diagnostic test: sensitivity, specificity, and likelihood ratio
| Diagnostic test | Evidence level | Gold standard | No of subjects | Sensitivity (95% CI) | Specificity (95% CI) | LR (95% CI) | Reference |
|---|---|---|---|---|---|---|---|
| Painful joint, swelling, abrupt onset, remission in 2 weeks(突然の関節痛・腫脹で2週以内に改善) | IIb | Clinical gout | 820 | 0.98 (0.95 to 1.02) | 0.23 (0.10 to 0.35) | 1.27 (1.08 to 1.50) | 11 |
| Erythema(発赤) | IIb | Clinical gout | 790 | 0.92 (0.88 to 0.96) | 0.62 (0.58 to 0.66) | 2.44 (2.19 to 2.73) | 12 |
| Podagra(第一中足趾関節の発赤) | Ib | Clinical gout | 1681 | 0.96 (0.91 to 1.01) | 0.97 (0.96 to 0.98) | 30.64 (20.51 to 45.77) | 11, 12 |
| Definite tophus(痛風結節) | Ib | Clinical gout | 1685 | 0.30 (0.24 to 0.36) | 0.99 (0.99 to 1.00) | 39.95 (21.06 to 75.79) | 11, 12 |
| Possible tophus | Ib | Clinical gout | 1536 | 0.20 (0.13 to 0.27) | 1.00 (0.99 to 1.00) | 33.99 (10.71 to 107.85) | 11, 12 |
| Urate crystals | |||||||
| Acute gout | IIb | Clinical gout | 456 | 0.84 (0.77 to 0.92) | 1.00 (0.99 to 1.00) | 566.60 (35.46 to 9053.50) | 12 |
| Intercritical gout | IIb | Urate crystals | 33 | 0.70 (0.50 to 0.87) | 0.95 (0.83 to 1.08) | 15.13 (0.99 to 229.95) | 13 |
| SUA (mg/dl) | |||||||
| >6 | IIb | Urate crystals | 32 | 0.67 (0.47 to 0.87) | 0.78 (0.51 to 1.05) | 3.00 (0.85 to 10.57) | 14 |
| Male >7 and female >6 | Ib | Clinical gout | 4224 | 0.57 (0.44 to 0.70) | 0.92 (0.93 to 0.94) | 7.61 (5.31 to 10.91) | 11, 15, 16 |
| Hyperuricaemia (>mean+2SD) | IIb | Clinical gout | 820 | 0.92 (0.88 to 0.51) | 0.91 (0.88 to 0.93) | 9.74 (7.45 to 12.72) | 11 |
| Radiology | |||||||
| Asymmetrical swelling | IIb | Clinical gout | 719 | 0.42 (0.33 to 0.51) | 0.90 (0.87 to 0.92) | 4.13 (2.97 to 5.74) | 12 |
| Subcortical cysts, no erosion | IIb | Clinical gout | 716 | 0.12 (0.06 to 0.18) | 0.98 (0.97 to 0.99) | 6.39 (3.00 to 13.57) | 12 |
| Grade I | IIb | Definite tophus | 4 | 1.00 | 0.00 | 1.00 | 17 |
| Grade II | IIb | Definite tophus | 9 | 0.95 (0.86 to 1.24) | 0.07 (−0.01 to 0.15) | 1.03 (0.90 to 1.16) | 17 |
| Grade III | IIb | Definite tophus | 35 | 0.86 (0.71 to 1.01) | 0.23 (0.09 to 0.35) | 1.10 (0.87 to 1.40) | 17 |
| Grade IV | IIb | Definite tophus | 15 | 0.57 (0.36 to 0.78) | 0.93 (0.85 to 1.01) | 8.00 (2.53 to 25.31) | 17 |
X ray grades: grade I, periarticular soft tissue swelling; grade II, tophaceous deposits, eccentric or asymmetrical nodular soft tissue masses with or without calcifications; grade III, cartilaginous and osseous destruction or grade II findings plus intra‐articular or extra‐articular erosions of bone and/or joint space narrowing; grade IV, grade III finding plus intraosseous calcific deposits, subperiosteal apposition of bone, or bony ankylosis.
CI, confidence interval; LR, likelihood ratio; SUA, serum uric acid.
尿酸値＞6mg/dl
感度67%、特異度78%、LR+3.0、LR-0.42
男性；尿酸値＞7mg/dl・女性：＞6mg/dl
感度57%、特異度92%、LR+7.6、LR-0.47
と尿酸値が高くなくても、痛風は否定できない。