医学
痛风
滑液
接收机工作特性
单关节炎
逻辑回归
尿酸
高尿酸血症
内科学
关节炎
人口
痛风性关节炎
曲线下面积
胃肠病学
病理
骨关节炎
替代医学
环境卫生
作者
Hein J.E.M. Janssens,Jaap Fransen,E.H. van de Lisdonk,P.L.C.M. van Riel,Chris van Weel,Matthijs Janssen
出处
期刊:Archives of internal medicine
[American Medical Association]
日期:2010-07-12
卷期号:170 (13)
被引量:184
标识
DOI:10.1001/archinternmed.2010.196
摘要
Background: Most cases of acute gouty arthritis are diagnosed in primary care and without joint fluid analysis in many instances.Our objectives were to estimate the validity of this diagnosis by family physicians and to develop a diagnostic rule.Methods: Patients with monoarthritis recruited in an open Dutch population with gout by family physician diagnosis were enrolled in a diagnostic study (March 24, 2004, through July 14, 2007).Validity variables were estimated using 2ϫ2 tables, with the presence of synovial monosodium urate crystals as the reference test.For development of the diagnostic rule, clinical variables (including the presence of synovial monosodium urate crystals) were collected within 24 hours.Statistically significant variables and predefined variables were separately entered in multivariate logistic regression models to predict the presence of synovial monosodium urate crystals.Diagnostic performance of the models was tested by receiver operating characteristic curve analysis.The most appropriate model was transformed to a clinically useful diagnostic rule.Results: Threehundredtwenty-eightpatientswereincluded in the study.The positive and negative predictive values of family physician diagnosis of gout were 0.64 and 0.87, respectively.The most appropriate model contained the following predefined variables: male sex, previous patientreported arthritis attack, onset within 1 day, joint redness, first metatarsophalangeal joint (MTP1) involvement, hypertension or 1 or more cardiovascular diseases, and serum uric acid level exceeding 5.88 mg/dL (to convert serum uric acid level to micromoles per liter, multiply by 59.485).The area underthereceiveroperatingcharacteristiccurveforthismodel was 0.85 (95% confidence interval, 0.81-0.90).Performance did not change after transforming the regression coefficients to easy-to-use scores and was almost equal to that of the statistically optimal model (area under the receiver operating characteristiccurve,0.87;95%confidenceinterval,0.83-0.91). Conclusions:The validity of family physician diagnosis of acute gouty arthritis was moderate in this study.An easy-to-use diagnostic rule without joint fluid analysis was developed for their use.
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