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)

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.

痛風は、高尿酸血症とセットというわけではない。

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。