鉴别痛风性关节炎与焦磷酸钙疾病及其他关节炎。

Distinguishing gouty arthritis from calcium pyrophosphate disease and other arthritides.

作者信息

Löffler Christian, Sattler Horst, Peters Lena, Löffler Uta, Uppenkamp Michael, Bergner Raoul

机构信息

From the Department of Rheumatology, Nephrology, and Oncology, Klinikum Ludwigshafen, Ludwigshafen; Department of Nephrology, Hypertensiology, Rheumatology, University Hospital Mannheim, Mannheim; Center of Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany.C. Löffler, MD, Department of Rheumatology, Nephrology, and Oncology, Klinikum Ludwigshafen, University Hospital Mannheim, University of Heidelberg; H. Sattler, MD; L. Peters, MD, Department of Rheumatology, Nephrology, Oncology, Klinikum Ludwigshafen; U. Löffler, Dipl Psych, Center of Psychological Psychotherapy, University of Heidelberg; M. Uppenkamp, MD, PhD, Department of Rheumatology, Nephrology, Oncology, Klinikum Ludwigshafen; R. Bergner, MD, Department of Rheumatology, Nephrology, and Oncology, Klinikum Ludwigshafen, University Hospital Mannheim, University of Heidelberg.

出版信息

J Rheumatol. 2015 Mar;42(3):513-20. doi: 10.3899/jrheum.140634. Epub 2014 Nov 15.

DOI:10.3899/jrheum.140634

PMID:25399385

Abstract

OBJECTIVE

Differentiating gout, calcium pyrophosphate deposition disease (CPPD), and non-crystal-related inflammatory arthropathies (non-CRA) is essential but often clinically impossible. The sonographic double contour (DC) sign may have good specificity for gout in highly specialized centers, but it can be challenging to use it to distinguish gout from cartilage hyperenhancements in CPPD. We evaluated the diagnostic value of the DC sign alone and in combination with Doppler signals and uric acid (UA) levels in patients with acute arthritis.

METHODS

We retrospectively investigated 225 acutely inflamed joints and documented the presence of DC, Doppler hypervascularization, and serum UA (SUA) levels. All patients underwent synovial fluid (SF) analysis. Sensitivity, specificity, and positive predictive values were calculated, and correlation analyses and a binary regression model were used to investigate their diagnostic values.

RESULTS

The sensitivity of DC sign for crystalline arthritides was 85% and specificity 80%. Its specificity for gout was 64%, for CPPD 52%. In contrast to non-CRA hypervascularization, degree 2 and 3 Doppler signals were highly associated with gout and less with CPPD (p < 0.01). The combination of DC sign with hypervascularization and elevated UA levels increased specificity for gout to more than 90% and resulted in a 7-fold increase of the likelihood of diagnosis of gout (p < 0.01), but with a loss of sensitivity (42%).

CONCLUSION

The DC sign alone is suitable for predicting crystal-related arthropathies, but it cannot reliably distinguish gout from CPPD in everyday clinical routine. Combining hypervascularization and SUA levels increases the diagnostic value, leading us to propose a diagnostic algorithm.

摘要

目的

鉴别痛风、焦磷酸钙沉积病（CPPD）和非晶体相关性炎性关节病（非CRA）至关重要，但在临床上往往难以做到。超声双轮廓（DC）征在高度专业化的中心对痛风可能具有良好的特异性，但用它来区分痛风与CPPD中的软骨强化可能具有挑战性。我们评估了DC征单独以及联合多普勒信号和尿酸（UA）水平在急性关节炎患者中的诊断价值。

方法

我们回顾性研究了225个急性发炎的关节，并记录了DC征、多普勒血管增生和血清UA（SUA）水平的情况。所有患者均接受了滑液（SF）分析。计算了敏感性、特异性和阳性预测值，并使用相关性分析和二元回归模型来研究它们的诊断价值。

结果

DC征对结晶性关节炎的敏感性为85%，特异性为80%。其对痛风的特异性为64%，对CPPD为52%。与非CRA的血管增生不同，2级和3级多普勒信号与痛风高度相关，与CPPD的相关性较小（p<0.01）。DC征与血管增生及UA水平升高相结合，使痛风的特异性提高到90%以上，并使痛风诊断的可能性增加了7倍（p<0.01），但敏感性有所下降（42%）。