Diagnostiek van jicht door huisarts en reumatoloog

Introduction/hypothesis: To improve the diagnosis of gout in primary care, a ´diagnostic rule´ has been described recently. Criteria are: male sex, previous patient reported 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 0.35 mmol / L. The objectives of this study are to calculate the sensitivity and specificity in patients referred to a rheumatologist with the presence of synovial monosodium urate crystals as the gold standard in diagnosing gout. In addition, the reasons of general practitioners (GPs) to refer a patient to the hospital were investigated and compared with the Dutch practice guideline “gout”. Material & Method: At the outpatient clinic of the Medical Centre Leeuwarden 2177 unique new patients were retrospective selected. These patients were classified on the GPs referral of gout/no gout. Of the patients referred with gout, the outcome of the diagnostic rule was compared with the presence of synovial monosodium urate crystals. Results: 148 patients were included in the study. 35 of hem were found to have no gout, 71 got de diagnosis of ‘clinical gout’ and 42 patients were found with synovial monosodium urate crystals. The last two groups together had a sensitivity of 85-95% and a specificity of 63%. Discussion this is the first study which investigated the value of the diagnostic rule in the hospital setting. The most striking outcome of this retrospective study is the relative low percentage of crystal-proven cases in daily practice. The diagnostic rule appears to be a good alternative for diagnosis of gout both in primary care and in rheumatology. In addition, there appears little consensus among GPs about criteria for referral and treatment of gout. They don’t always follow the national practice guideline “gout”.