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Impact of disease duration and gender on the sensitivity and specificity of 2015 ACR/EULAR classification criteria for gout. Cross-sectional results from an Italian multicentric study on the management of crystal-induced arthritis (ATTACk)


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20
Collaborator/s: T. Del Ross1, F. Salaffi2, E. Fusaro3, M. Govoni4, M. Manara5, A. Murgo6, L. Rotunno7, A. Zoli8

 

  1. Department of Medicine-DIMED, Rheumatology Unit, Padova University Hospital, Padova, Italy.
  2. Rheumatology Division, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, and Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy.
  3. Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliera Universitaria di Parma, Italy.
  4. Rheumatology, Central Hospital of Bolzano, Italy.
  5. Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, Italy.
  6. Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, Italy.
  7. Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona, Ferrara, Italy.
  8. Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy.
  9. Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
  10. Department of Medicine-DIMED, Rheumatology Unit, Padova University Hospital, Padova, and UO Medicina Generale, Ospedale Riabilitativo di Alta Specialità - ORAS- Motta di Livenza, Treviso, Italy.
  11. Department of Medicine-DIMED, Rheumatology Unit, Padova University Hospital, Padova, and Internal Medicine Unit, Department of Medicine, San Bortolo Hospital of Vicenza, Italy.
  12. Department of Medicine-DIMED, Rheumatology Unit, Padova University Hospital, Padova, Italy.
  13. Department of Medicine-DIMED, Rheumatology Unit, Padova University Hospital, Padova, and Internal Medicine 1, Ca’ Foncello Hospital, ULSS2 Marca Trevigiana, Treviso, Italy.
  14. SC Reumatologia, AOU Città della Salute e della Scienza, Torino, Italy.
  15. Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona, Ferrara, Italy.
  16. Epidemiology Unit, Italian Society for Rheumatology, Milan, and Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
  17. Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.
  18. Epidemiology Unit, Italian Society for Rheumatology, Milan, and Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona, Ferrara, Italy.
  19. Department of Medicine-DIMED, Rheumatology Unit, Padova University Hospital, Padova, Italy.
  20. University of Padova, Department of Medicine-DIMED, Rheumatology Unit, Padova, Italy.

  1. Rheumatology Unit, Department of Medicine-DIMED, University Hospital of Padova, Italy.
  2. Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
  3. SC Reumatologia, AOU Città della Salute e della Scienza, Torino, Italy.
  4. Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona, Ferrara, Italy.
  5. Department of Rheumatology, ASST Gaetano Pini-CTO, Milano, Italy.
  6. Department of Rheumatology, ASST Gaetano Pini-CTO, Milano, Italy.
  7. Department of Rheumatology, ASST Gaetano Pini-CTO, Milano, Italy.
  8. Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.

on behalf of the SIR Study Group ATTACk

CER14570
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PMID: 34665701 [PubMed]

Received: 26/02/2021
Accepted : 30/08/2021
In Press: 28/09/2021

Abstract

OBJECTIVES:
We aimed to assess the performance of the 2015 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) gout classification criteria in an Italian cohort of patients with crystal-induced arthritis stratified by disease duration and gender in a real-life setting.
METHODS:
Consecutive patients referred to Rheumatology Units for suspected acute crystal-induced arthritis were enrolled in a multicentre cohort study by the Italian Society of Rheumatology which was designed to improve the management of crystal-induced arthritis (ATTACk). To test the performance of the criteria (sensitivity and specificity), the presence of monosodium urate (MSU) crystals in synovial fluid (SF) was used as gold standard. Subgroup analyses by gender and disease duration were performed.
RESULTS:
Two hundred and seventy-seven patients were enrolled. SF analysis was available in 137 (49%) patients. Complete SF analysis and ACR/EULAR scores were obtained in 44% of patients. MSU crystals were found in 66% of patients. The sensitivity and the specificity of all criteria sets were 78% (95%CI, 67–86) and 98% (95%CI, 87–100), respectively; only clinical criteria yielded 70% (95%CI, 59–80) sensitivity and 93% (95%CI, 80-98) specificity, respectively. In early-stage disease (<2 years), the sensitivity dropped to 58% (95%CI, 39-75), while the specificity was 100% (95%CI, 85–100).
CONCLUSIONS:
The ACR/EULAR criteria showed good performance in patients presenting with acute arthritis; changes were observed when a subset of criteria were used, especially in early-stage disease.

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