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)
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)
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DOI：
10.1136/ard.2006.055251
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发表时间：
2006-10-01
影响因子：
27.4
通讯作者：
Zimmermann-Gorska, I.
中科院分区：
文献类型：
--
作者：
Zhang, W.;Doherty, M.;Zimmermann-Gorska, I.
目标：发展的证据为基础的建议，痛风的诊断。方法：多学科的指南开发组包括19风湿病学家和一个证据为基础的医学专家，代表13个欧洲国家。使用德尔菲共识方法生成了有关诊断的十个关键命题。对每一个命题都进行了系统的研究。尽可能计算诊断试验的敏感性、特异性、似然比（LR）和增量成本-效果比。相对风险和比值比估计的危险因素和并发症与痛风。根据证据等级对证据质量进行分类。使用EULAR视觉模拟和顺序scales.Results的推荐强度（SOR）进行了评估：10个关键命题，通过三个德尔菲轮，包括诊断主题的临床表现，尿酸盐晶体识别，生化检查，放射照片，和危险因素/合并症。尿酸盐晶体的鉴定根据症状和观察者的技能而不同，但在有症状的痛风中很可能是阳性的（LR = 567（95%置信区间（CI），35.5至9053））。典型足突和痛风石的存在对痛风具有最高的临床诊断价值（LR = 30.64（95%CI，20.51至45.77），LR = 39.95（21.06至75.79），分别）。高尿酸血症是痛风的主要危险因素，当根据当地人群的正常范围（LR = 9.74（7.45 - 12.72））定义时，高尿酸血症可能是一个有用的诊断标志物，尽管一些痛风患者在研究时可能具有正常的血清尿酸浓度。X线片在诊断中作用不大，但在晚期或重度痛风中，不对称肿胀（LR = 4.13（2.97至5.74））和皮质下囊肿无侵蚀（LR = 6.39（3.00至13.57））的X线改变可能有助于将慢性痛风与其他关节疾病区分开来。此外，风险因素（性别、利尿剂、富含嘌呤的食物、酒精、铅）和合并症（心血管疾病、高血压、糖尿病、肥胖和慢性肾衰竭）与痛风有关。SOR为每个命题根据研究证据和专家opinion.Conclusions：10个关键的建议，诊断痛风的开发使用的研究为基础的证据和专家共识相结合。对诊断试验、风险因素和合并症的证据进行了评价，并提供了建议的强度。
Objective: To develop evidence based recommendations for the diagnosis of gout.Methods: The multidisciplinary guideline development group comprised 19 rheumatologists and one evidence based medicine expert, representing 13 European countries. Ten key propositions regarding diagnosis were generated using a Delphi consensus approach. Research evidence was searched systematically for each proposition. Wherever possible the sensitivity, specificity, likelihood ratio (LR), and incremental cost-effectiveness ratio were calculated for diagnostic tests. Relative risk and odds ratios were estimated for risk factors and co-morbidities associated with gout. The quality of evidence was categorised according to the evidence hierarchy. The strength of recommendation (SOR) was assessed using the EULAR visual analogue and ordinal scales.Results: 10 key propositions were generated though three Delphi rounds including diagnostic topics in clinical manifestations, urate crystal identification, biochemical tests, radiographs, and risk factors/comorbidities. Urate crystal identification varies according to symptoms and observer skill but is very likely to be positive in symptomatic gout (LR = 567 (95% confidence interval (CI), 35.5 to 9053)). Classic podagra and presence of tophi have the highest clinical diagnostic value for gout (LR = 30.64 ( 95% CI, 20.51 to 45.77), and LR = 39.95 (21.06 to 75.79), respectively). Hyperuricaemia is a major risk factor for gout and may be a useful diagnostic marker when defined by the normal range of the local population (LR = 9.74 (7.45 to 12.72)), although some gouty patients may have normal serum uric acid concentrations at the time of investigation. Radiographs have little role in diagnosis, though in late or severe gout radiographic changes of asymmetrical swelling ( LR = 4.13 ( 2.97 to 5.74)) and subcortical cysts without erosion ( LR = 6.39 (3.00 to 13.57)) may be useful to differentiate chronic gout from other joint conditions. In addition, risk factors ( sex, diuretics, purine-rich foods, alcohol, lead) and co-morbidities ( cardiovascular diseases, hypertension, diabetes, obesity, and chronic renal failure) are associated with gout. SOR for each proposition varied according to both the research evidence and expert opinion.Conclusions: 10 key recommendations for diagnosis of gout were developed using a combination of research based evidence and expert consensus. The evidence for diagnostic tests, risk factors, and co-morbidities was evaluated and the strength of recommendation was provided.