Compliance with the European League Against Rheumatism (EULAR) diagnostic propositions for gout4 in hospitalized patients with gout seen by rheumatology service compared to controls. EULAR propositions 4 and 5 were not included as they recommend searching for crystals in all joint aspirates and in noninflamed joints during intercritical periods, respectively.
| EULAR Diagnostic Propositions | Variable | Seen by Rheumatology | p | |
|---|---|---|---|---|
| No = 59, % (n) | Yes = 79, % (n) | |||
| 1. “In acute gout the rapid development of severe pain, swelling, and tenderness that reaches its maximum in 6–12 hours especially with erythema is highly suggestive of gout...” | 25 (42.4) | 40 (50.6) | 0.336 | |
| 2. “For typical presentations such as recurrent podagra with hyperuricemia, a clinical diagnosis alone is reasonably accurate...” | 2 (3.4) | 3 (3.8) | 1.000* | |
| 3. Demonstration of urate crystals permits a definitive diagnosis of gout | Synovial fluid analyzed | 11 (18.6) | 41 (51.9) | < 0.001 |
| Crystals present | 11 (18.6) | 32 (40.5) | 0.006 | |
| 6. Was a Gram stain or culture done? | 11 (18.6) | 35 (44.3) | 0.002 | |
| 7. Was serum urate level done? | Serum urate | 40 (67.8) | 68 (86.1) | 0.010 |
| Mean serum urate μmol/l | 476.9 ± 170.0 | 501.0 ± 167.0 | 0.547 | |
| 8. Was renal uric acid excretion documented? | 0 | 1 (1.3) | 1.000* | |
| 9. Were radiographs taken? | Radiograph | 25 (42.4) | 41 (52.0) | 0.268 |
| Findings in keeping with gout | 2 (8.0) | 10 (24.4) | 0.113* | |
| 10. Risk factors and comorbidities should be assessed | Hypertension | 44 (74.6) | 57 (72.2) | 0.543 |
| Hyperglycemia | 18 (30.5) | 28 (35.4) | 0.543 | |
| Hyperlipidemia | 22 (37.3) | 26 (33.0) | 0.593 | |
| Obesity | 22 (37.9) | 26 (33.8) | 0.617 | |
↵* Fisher’s exact test.