EULAR关于痛风诊断的推荐建议

EULAR关于痛风诊断的推荐建议 1. 关节炎急性发作时，表现为快速发生的严重疼痛、肿胀和压痛，6-12小时达高峰，尤其是皮肤表面发红，虽对痛风诊断无特异性，但高度提示晶体性炎症。推荐力度和95%的可信区间分别为88和80~96。 2.有典型的痛风（如复发性痛风足），单纯临床诊断应是准确的，但未证实晶体的存在不能确诊痛风。推荐力度和95%的可信区间分别为95 和91~98。 3.滑液或痛风石吸取物中证实有尿酸盐结晶可确诊痛风。推荐力度和95%的可信区间分别为96和93~100。 4.对不能确诊的炎性关节炎，均推荐在其滑液中常规找尿酸盐结晶。推荐力度和95%的可信区间分别为90和83~97。 5.无症状性关节内证实有尿酸盐结晶可确诊痛风间歇期。推荐力度和95%的可信区间分别为84和78~91。 6.痛风与败血症可同时存在，故怀疑化脓性关节炎时，即使证实有尿酸盐晶体存在，也应行革兰染色和滑液培养。推荐力度和95%的可信区间分别为93 和87~99。 7.作为痛风最重要的危险因素，血尿酸的高低不能证实或排除痛风，因不少的高尿酸血症者不发展为痛风，而在痛风急性发作期，血尿酸水平可正常。推荐力度和95%的可信区间分别为95和92~99。 8. 某些痛风患者，尤其是有家族史的年轻痛风患者（年龄小于25岁的发作者）或有肾结石者，应行肾脏尿酸分泌测定。推荐力度和95%的可信区间分别为72 和62~81 9. 虽然放射线有助于鉴别诊断，且可显示慢性痛风的典型特征，但对早期或急性痛风的确诊无帮助。推荐力度和95%的可信区间分别为86和79~94。 10.应评估痛风和相关并发症包括代谢综合症（肥胖、高脂血症、高血糖、高血压）的危险因素。推荐力度和95%的可信区间分别为93和88~98。 注：数值为视觉模拟尺 (范围0–100 mm, 0=不推荐, 100 =完全推荐) 附原文：1. In acute attacks the rapid development of severe pain, swelling, and tenderness that reaches its maximum within just 6–12 hours, especially with overlying erythema, is highly suggestive of crystal inflammation though not specific for gout. Strength of recommendation：VAS (95% CI) : 88 (80 to 96) 2.For typical presentations of gout (such as recurrent podagra with hyperuricaemia) a clinical diagnosis alone is reasonably accurate but not definitive without crystal confirmation. Strength of recommendation：VAS (95% CI) : 95 (91 to 98) 3.Demonstration of MSU crystals in synovial fluid or tophus aspirates permits a definitive diagnosis of gout. Strength of recommendation：VAS (95% CI) : 96 (93 to 100) 4.A routine search for MSU crystals is recommended in all synovial fluid samples obtained from undiagnosed inflamed joints 90 (83 to 97) 5.Identification of MSU crystals from asymptomatic joints may allow definite diagnosis in intercritical periods. Strength of recommendation：VAS (95% CI) : 84 (78 to 91) 6.Gout and sepsis may coexist, so when septic arthritis is suspected Gram stain and culture of synovial fluid should still be performed even if MSU crystals are identified. Strength of recommendation：VAS (95% CI) : 93 (87 to 99) 7.While being the most important risk factor for gout, serum uric acid levels do not confirm or exclude gout as many people with hyperuricaemia do not develop gout, and during acute attacks serum levels may be normal. Strength of recommendation：VAS (95% CI) : 95 (92 to 99) 8.Renal uric acid excretion should be determined in selected gout patients, especially those with a family history of young onset gout, onset of gout under age 25, or with renal calculi. Strength of recommendation：VAS (95% CI) : 72 (62 to 81) 9.Although radiographs may be useful for differential diagnosis and may show typical features in chronic gout, they are not useful in confirming the diagnosis of early or acute gout. Strength of recommendation：VAS (95% CI) : 86 (79 to 94) 10.Risk factors for gout and associated co-morbidity should be assessed, including features of the metabolic syndrome (obesity, hyperglycaemia, hyperlipidaemia, hypertension). Strength of recommendation：VAS (95% CI) : 93 (88 to 98) 引自：W Zhang, M Doherty, E Pascual,et al. 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). Ann Rheum Dis, 2006,65:1301-1311