Malik Aarti, Schumacher H Ralph, Dinnella Janet E, Clayburne Gilda M
University of Pennsylvania, VA Medical Center, Philadelphia, Pennsylvania, USA.
J Clin Rheumatol. 2009 Feb;15(1):22-4. doi: 10.1097/RHU.0b013e3181945b79.
Several classification or diagnostic criteria sets for gout have been proposed but none validated.
This small pilot study considered urate crystal identification as the gold standard for diagnosis and compared the clinical aspects of 3 proposed criteria sets with that standard.
Eighty-two subjects who had synovial fluid analyses in a VA medical center were studied. ARA (ACR), Rome, and New York clinical criteria sets and individual criteria were recorded in the 30 patients who had urate crystals versus the remainder with no urate crystals.
Presence of 2 of 3 Rome clinical criteria had the highest positive predictive value at 76.9%. None of the 3 studied criteria sets were more than 70% sensitive or 88.5% specific. The clinical features of the ARA (ACR) preliminary classification criteria had 70% sensitivity and 78.8% specificity.
The various proposed clinical criteria can provide support for a diagnosis or exclusion of gout, but unless improved criteria can be developed crystal identification should remain the gold standard.
已经提出了几种痛风的分类或诊断标准集，但均未得到验证。
这项小型试点研究将尿酸盐晶体鉴定视为诊断的金标准，并将3种提议的标准集的临床情况与该标准进行比较。
对在一家退伍军人医疗中心进行滑液分析的82名受试者进行了研究。在30名有尿酸盐晶体的患者与其余没有尿酸盐晶体的患者中记录了美国风湿病学会（ARA，现称美国风湿病学会[ACR]）、罗马和纽约临床标准集以及个体标准。
罗马临床标准中3条中的2条存在时，阳性预测值最高，为76.9%。所研究的3种标准集中没有一种的敏感性超过70%或特异性超过88.5%。ARA（ACR）初步分类标准的临床特征敏感性为70%，特异性为78.8%。
各种提议的临床标准可为痛风的诊断或排除提供支持，但除非能制定出改进的标准，否则晶体鉴定仍应作为金标准。
