Study on clinical and paraclinical characteristics of patients with gout disease diagnosed by the 2015 eular/acr criteria

Nội dung text: Study on clinical and paraclinical characteristics of patients with gout disease diagnosed by the 2015 eular/acr criteria

1. Journal of military pharmaco-medicine STUDY 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 characteristics and incorporate current Gout is the most prevalent form of modern evidence regarding gout, has higher inflammatory arthritis and is associated sensitivity (92%) and higher specificity with impaired quality of life. There are (89%) than existing criteria. In Vietnam, many criteria for diagnosing gout disease, Bennett & Wood classification criterion existing criteria for the classification of has been mainly used to diagnose gout gout have suboptimal sensitivity and/or disease, the advantages of these criteria specificity and were developed at a time are to diagnose based on clinical when advanced imaging was not available. manifestations, easy to remember and apply Therefore, it is necessary to develop a but with low sensitivity and specificity. new diagnostic tool. The 2015 EULAR/ACR Thus, this study aims: To use new criteria gout classification criteria are developed EULAR/ACR 2015 to diagnose gout using a data-driven and decision analytic disease and analyze the collected clinical approach, have excellent performance 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 158
2. Journal of military pharmaco-medicine SUBJECTS AND METHODS classification diagnosis was made by the 1. Subjects. 2015 EULAR/ACR criteria with the total mark more than 8 marks (96.8%). Only * Inclusion criteria: one patient with poor clinical findings was 31 patients including 30 male patients diagnosed by detecting urate crystal using were treated in the Rheumatology and polarized light microscopy. Endocrinology Department, 103 Hospital. In our study, the mean age of onset - Diagnosed with gout disease by the was rather young (47.3 ± 15.2). The most EULAR/ACR 2015 criteria. common age group of onset was 20 - 40 - The affected joints were in inflammatory (41.9%). This result was consistent with condition with or without joint effusion. the result of Hoang Thi Thu Trang * Exclusion criteria: Suspected bacterial infection of the joints or other infection (48.8%). It also suggested that the onset conditions that affect to the evaluation of of gout had the tendency of rejuvenation. the inflammatory investigation results. This matched with the tendency of having metabolism diseases in our modern 2. Methods. society. Cross-sectional, descriptive analysis. * Examination and diagnosis: The group with overweight and obesity accounted for 41.9%, the mean BMI was - Take a history, age, gender; examine the affected joints and assess pain levels 22.4 ± 2.6. This result was also consistent of joints (VAS), investigate ESR, hs-CRP, with the result of Hoang Thi Thu Trang plasma uric acid concentration, performed studied on Vietnamese (50.1%). In the ultrasound the affected joints for detecting study of L Annemans (2010), obesity double contour. accounted for 27.7% of UK patients [2]. - Patients with gout disease were According to Lucía Cea Soriano (2011), definitely diagnosed by the 2015 this rate was 65.99% [6]. Recent studies EULAR/ACR criteria. have approved that obesity played an * Method of data analysis: important role in increasing the prevalence Collected data were analyzed by the of gout [7]. medical statistical method using SPSS The heavy pain was the highest ratio 23.0 software. (74.2%) and the mean VAS was 73.5 ± RESULTS AND DISCUSSIONS 21.2. The result was consistent with the 1. Clinical and paraclinical result of Hoang Thi Thu Trang (68.8%) characteristics. [1], Pham Thi Minh Nham (79.2%) [5]. * Clinical characteristics: The result also matched with the In total, we identified 31 patients with intensely painful condition in the gout disease. In most cases, the pathophysiology of gout. 159
3. Journal of military pharmaco-medicine Table 1: Inhabit of alcoholic beverage using. Quantity Acid uric p Min - Max Alcohol (n = 26) Quantity (g/day) 108.3 ± 80.9 16 - 320 497.9 ± 110.4 (83.9%) Time (year) 31.9 ± 14.5 5 - 60 > 0.05 Beer (n = 14) Quantity (g/day) 57.3 ± 37.2 4 - 120 485.2 ± 90.9 (45.2%) Time (year) 27.7 ± 12.2 10 - 50 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. Diagnostic features Number of patients Percentage Diagnosed with the first episode Yes 17 54.8 No 14 45.2 Time to be definitely diagnosed with gout Min 1 year disease (years) Max 15 years 4.64 ± 4.4 years Diagnosing gout has been a challenge shortest time for the definite diagnosis to the physicians in many cases because was 1 year, the longest time was 15 years of its various manifestations. In our study, and the mean time was 4.64 ± 4.4 years. there was still a high ratio of patients who Our result was shorter than the previous were not diagnosed with the first episode study of Le Thi Vien (2006): 5.98 ± 5.9 (45.2%). The mean time for the definite years [3] and consistent with the result of diagnosis was 4.64 years. In the study of Hoang Thi Thu Trang (2.34 ± 5.19 years). Hoang Thi Thu Trang, this rate was Because the patients paid more and more higher than ours (68.75%, p < 0.05). This attention to their health, so they visited may be in the study of Hoang Thi Thu hospital earlier, at the same time, the Trang using the Bennet Wood criteria so level of expertise of general doctors have the sensitivity and the specificity were improved and physicians in primary lower. With whom the diagnosis was not health care facilities have had a better established by the first episode, the understanding of gout. 160
4. Journal of military pharmaco-medicine * Paraclinical characteristics: was more common (80.6%), followed by 80.6% of patients in our study had the elevated level of ESR (53.6%), WBC elevated uric acid level. The mean plasma was almost normal (54.8%) with the mean uric acid was 503.9 ± 106.4 µmol/L. WBC 8.39 ± 4.9. These results were These results were consistent with consistent with the results of Hoang Thi previous studies Hoang Thi Thu Trang Thu Trang (93.8%, 73.1% and 55.9%) [1]. (69.4%; 499.13 ± 143.0 µmol/L) [1], Pham The results matched with the clinical Hoai Thu (65.3%; 470.2 ± 120.1 µmol/L) manifestations of acute gout and acute [4]. However, 19.4% of patients were flares of chronic gout disease. The WBC diagnosed acute gout and acute flare of increased without statistically significant chronic gout with normal plasma uric acid difference (42.5% vs. 54.8%, p > 0.05), this concentration. This rate was similar to the was absolutely consistent with the infectious result in the study by Hoang Thi Thu inflammatory process of gout disease. Trang (30.6%) [1]. This result showed that Synovitis was the most common lesion the uric acid concentration was not the on the ultrasound (41.9%), followed by definitive factor to activate the acute flares the double contour (29.0%). This result of gout. This had reported by previous was also similar to a previous study [1]. studies of many authors [8]. The double contour was a very valuable Gout is an inflammatory joint disease. lesion for diagnosing gout on ultrasound. So investigating the markers of inflammatory It indicated the deposition of urate crystals condition could show us the level of the in the joints and distributed 4 marks into inflammation. Hs-CRP, ESR and WBC the total 2015 score if positive. In our were the common inflammatory markers. study, we met 2 cases who were detected In our study, the elevated level of hs-CRP tophi on ultrasound (6.5%). Table 3: Plasma uric acid features. Acute flare of chronic gout Acute gout (n = 23) Total Plasma acid uric (n = 8) (µmol/L) n % n % n % Increase 20 64.5 5 16.1 25 80.6 Normal 3 9.7 3 9.7 6 19.4 491.2 ± 141.9 478.3 ± 142.3 503.9 ± 106.4 p > 0.05 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). 161
5. Journal of military pharmaco-medicine 2. 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. 30 25 20 15 10 y = 0.8842x - 2.8457 5 R2 = 0.2086 0 Frequency (numbers per year) 0 5 10 15 20 25 EULAR/ACR classification for gout marks Figure 1: The correlation between the EULAR/ACR 2015 classification for gout scores with the frequency of recurrence attacks of gout per year. CONCLUSION two common inflammatory markers. The - The majority were male (96.8%) with double contour lesion accounted for 29.0%. the mean age of onset 47.3 ± 15.2 years, - There was a moderate positive the common age group of onset was from correlation between the EULAR/ACR 20 to 40 (41.9%) and commonly with the 2015 classification for gout scores and the heavy pain (74.2%). 45.2% of patients frequency of recurrence attacks of gout were not diagnosed with the first episode per year (r = 0.46; p < 0.05). lower than previous study’s with statistical significance, the mean time for the REFERENCES definite diagnosis was 4.64 ± 4.4 years. 1. Hoàng Th ị Thu Trang. Kh ảo sát tinh th ể - 19.4% of patients who were diagnosed urat trong d ịch kh ớp ở b ệnh nhân gout và m ột acute gout and acute flare of chronic gout, số y ếu t ố liên quan. Lu ận v ăn Th ạc s ỹ Y h ọc. had normal value. Hs-CRP and ESR were Tr ường Đại h ọc Y Hà N ội. 2015. 162
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