Article Figures & Data
Figures
- Figure 1
The overlap and differences among features highly rated (median 7-9) by physicians and patients. US: ultrasound; DECT: dual-energy computed tomography; CT: conventional computed tomography; MRI: magnetic resonance imaging; MSU: monosodium urate.
Tables
Survey Items Median (30th to 70th percentile)† Disagreement Index†† Items agreed by physicians to be discriminatory MSU crystals present in joint aspirate/tissue 9 (9 to 9) 0 Tophi (especially in typical sites such as hands, helix of the ear, olecranon bursa, and Achilles tendon) 9 (8 to 9) 0.13 MSU crystals still present in the joint fluid despite the patient being asymptomatic 9 (7 to 9) 0.29 Radiographic erosions with sclerotic margins and overhanging cortical edges 8 (8 to 8) 0 First metatarsophalangeal joint (podagra) involved at the very first episode 8 (7 to 8) 0.16 Abrupt onset of an attack that peaks around 12–24 hours 8 (7 to 8) 0.16 Conventional CT tophi (soft-tissue masses of intermediate density) 8 (7 to 8) 0.16 Recurrent stereotypical episodes of attacks 8 (7 to 8) 0.16 MRI tophi (low to intermediate signal intensity on T1-weighted images) 8 (7 to 8) 0.16 MRI tophi (variable intensity on T2-weighted images) 8 (7 to 8) 0.16 Dual-energy CT to detect urate deposits 8 (7 to 8) 0.16 First metatarsophalangeal joint involved ever 7.5 (7 to 8) 0.16 US double-contour sign (hyperechoic band on the surface of articular cartilage) 7.5 (7 to 8) 0.16 Severe pain that is maximal within 4–12 hours 7 (7 to 8) 0.16 US tophi (hyperechoic, heterogeneous lesion surrounded by an anechoic rim) 7 (7 to 8) 0.16 Serum uric acid elevated during the intercritical period* 7 (7 to 8) 0.16 Attacks are monoarthritic in the first few years and become oligoarthritic and polyarthritic over time* 7 (7 to 8) 0.16 Between attacks, the patient appears well with no signs of pain or obvious inflammation 7 (6 to 8) 0.37 Redness/erythema around the affected joint observed by the physician 7 (6 to 8) 0.37 Marked joint tenderness — patient protects the affected joint from use or from being knocked 7 (6 to 7) 0.22 Monoarticular joint involvement in acute attacks 7 (6 to 7) 0.22 Resolution of an attack within 7–14 days 7 (6 to 7) 0.22 Raised serum urate level* 7 (6 to 7) 0.22 Joints of the midfoot are affected, observed by the physician* 7 (6 to 7) 0.22 Uric acid nephrolithiasis (kidney stones) 7 (5.1 to 8) 0.62 US joint effusion (snowstorm appearance due to MSU crystals within the synovial fluid) 7 (5 to 7) 0.52 Items agreed by physicians to be of uncertain discrimination Patient responds rapidly to low-dose colchicine treatment* 6.5 (6 to 7) 0.22 Swelling resolves once symptoms subside, observed by the physician 6.5 (5 to 7) 0.52 Serum uric acid elevated during acute attack of gout* 6.5 (5 to 7) 0.52 Warmth of skin overlying affected joint, as observed by the physician* 6 (6 to 7) 0.22 Onset of a gout attack is generally at night* 6 (6 to 7) 0.22 MRI erosion (a sharply marginated bone lesion with cortical bone defect)* 6 (6 to 7) 0.22 Conventional CT to detect urate deposits* 6 (6 to 7) 0.22 Conventional CT to detect erosion* 6 (6 to 7) 0.22 Swelling of associated bursa, observed by the physician 6 (5.3 to 7) 0.42 Other joints affected that are typical of gout (midfoot, ankle, knee) 6 (5.1 to 7) 0.48 Swelling in the joint, as observed by the physician* 6 (5 to 7) 0.52 Redness/erythema around the affected joint, as observed by the patient* 6 (5 to 7) 0.52 Precipitation of an episode by purine-containing food (such as seafood or red meat), alcohol, dehydration, or drugs (such as diuretics) 6 (5 to 7) 0.52 Swelling resolves once symptoms subside, as observed by the patient* 6 (5 to 7) 0.52 Chronic uric acid nephropathy* 6 (5 to 7) 0.52 If the patient is female she is postmenopausal* 6 (5 to 7) 0.52 Patient is unable to wear shoes* 6 (5 to 7) 0.52 Skin peels/scales over the affected area as acute attack is resolving* 6 (5 to 7) 0.52 Previous diagnosis of gout made by another physician* 6 (5 to 7) 0.52 Other joints are affected that are typical of gout such as ankle and knee, observed by the physician* 6 (5 to 6) 0.32 Patient has a history of chronic, heavy alcohol intake* 6 (5 to 6) 0.32 Patient is taking medication such as diuretics* 6 (5 to 6) 0.32 Patient is a male* 6 (5 to 6) 0.32 Patient is an organ graft recipient* 6 (4.3 to 7) 0.81 Synovial fluid cultures of affected joint are negative for organisms (to exclude septic arthritis)* 6 (4.3 to 6) 0.66 Family history of gout* 5.5 (5 to 6) 0.32 Redness of skin with skip area (suggestive of gouty cellulitis), which can eliminate cellulitis (redness of skin without skip area)* 5.5 (5 to 6) 0.32 US erosion (break in the cortical contour)* 5 (5 to 6) 0.32 US tendon pathology (includes tenosynovitis, tendinosis, and intratendinous tophi)* 5 (5 to 6) 0.32 Reduced renal uric acid excretion* 5 (4.3 to 6) 0.66 Swelling of associated bursa, as observed by the patient* 5 (4 to 6) 0.85 Warmth of skin overlying the affected joint, as observed by the patient* 5 (4 to 6) 0.85 Asymmetric joint involvement, as observed by the physician* 5 (4 to 6) 0.85 Patient has a high purine diet (i.e., consumes large amounts of red meat and shellfish)* 5 (4 to 6) 0.85 Patient is obese* 5 (4 to 6) 0.85 Patient has previously had a cardiovascular disease such as heart failure or myocardial infarction* 5 (4 to 6) 0.85 US power Doppler signal (PWD 2–3) in monoarthritis* 5 (4 to 6) 0.85 Elevated neutrophils within the synovial fluid* 5 (4 to 5) 0.32 Patient is top aged (40–50 years old)* 5 (4 to 5) 0.32 Swelling in the joint, as observed by the patient* 5 (3 to 6) 0.97 Elevated leukocytes within the synovial fluid* 5 (3 to 5) 0.52 Inflammatory cells present in fluid aspirated from affected joint* 5 (3 to 5) 0.52 Pain is relieved by joint aspiration* 4.5 (3 to 5) 0.52 Patient also suffers from diabetes* 4 (4 to 5) 0.32 Elevated serum C-reactive protein* 4 (3.3 to 5) 0.47 Pain prevents walking* 4 (3 to 5.7) 0.81 Asymmetric joint involvement, as observed by the patient* 4 (3 to 5) 0.52 Acute uric acid nephropathy* 4 (3 to 5) 0.52 Elevated erythrocyte sedimentation rate* 4 (3 to 5) 0.52 Aspiration of previously affected joint shows elevated leukocyte count in joint fluid* 4 (3 to 4) 0.22 MRI synovitis (an area of synovial compartment is enhanced with contrast, and is thicker than the width of normal synovium)* 4 (3 to 4) 0.22 US calcium deposits (focal hyperechoic deposits within hyaline cartilage)* 4 (3 to 4) 0.22 Items agreed by physicians to be not discriminatory Polyarticular disease, as observed by the physician* 3.5 (3 to 4) 0.22 Fewer than 5 joints affected 3 (3 to 5) 0.52 Fever 3 (3 to 5) 0.52 Polyarticular disease, observed by the patient 3 (3 to 4) 0.22 Patient has hypertension* 3 (3 to 4) 0.22 Functional disability (difficulty with daily activities) 3 (2 to 5) 0.65 Loss of function of the joint (due to loss of joint motion) 3 (2 to 4.9) 0.62 MRI cartilage pathology (focal and diffuse narrowing) 3 (2 to 4.9) 0.62 Calcium nephrolithiasis 3 (2 to 4) 0.37 Radiographic joint space abnormalities (includes widening, narrowing, and ankylosis) 3 (2 to 4) 0.37 Patient complains of flu-like symptoms 3 (1.1 to 4) 0.48 Malaise 3 (1.1 to 4) 0.48 Elevated platelet count 2 (1.1 to 4) 0.48 Early morning stiffness lasting > 30 minutes 2 (1 to 2.9) 0.27 Spinal involvement 2 (1 to 2) 0.13 -
↵* Rating from final iteration.
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↵† Values of 1–3.5 indicate the item was considered not discriminatory for gout, 4–6.5 as uncertain, and 7–9 as discriminatory for gout.
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↵†† Disagreement index > 1 indicates disagreement18. US: ultrasound; CR: conventional radiology; CT: computed tomography; MRI: magnetic resonance imaging; MSU: monosodium urate.
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Survey Items Median (30th to 70th percentile) Rating† Disagreement Index†† Items agreed by patients as being discriminatory Blood test shows an increase in uric acid in the blood 9 (9 to 9) 0 During an attack of gout the pain is so bad you find it hard to walk 9 (9 to 9) 0 During an attack of gout you cannot use the affected joint 9 (8.6 to 9) 0.05 During an attack of gout the pain is so bad it interrupts your sleep 9 (8.2 to 9) 0.1 During an attack of gout the joint is so sensitive you cannot even sleep with a sheet touching the affected area 9 (7.2 to 9) 0.26 Medication such as indomethacin, allopurinol, or colchicine keeps the gout attacks at bay 9 (6.6 to 9) 0.37 The pain is of a throbbing type 9 (5.6 to 9) 0.59 Presence of crystals from joint fluid under a microscope 9 (5.6 to 9) 0.59 An attack of gout often occurs after eating seafood/shellfish* 8 (7 to 9) 0.29 Onset of an attack is sudden 8 (6.6 to 9) 0.37 The big toe is affected 8 (6 to 9) 0.49 The affected joint is hot 8 (5.6 to 9) 0.59 The affected joint is red 8 (5.6 to 9) 0.59 Tophi (lumps) are present in areas such as the elbows, fingers, and toes 8 (5 to 9) 0.75 The pain is annoying 8 (4.2 to 8.4) 0.98 A flare-up of an attack of gout responds rapidly to medication such as prednisone or naproxen 7 (7 to 7.8) 0.13 The affected area is very sensitive to touch 7 (6.2 to 9) 0.45 The affected joint is swollen 7 (6 to 9) 0.49 An attack of gout often occurs after consuming alcohol* 7 (6 to 8.6) 0.45 Severe, sharp pain in the affected joint 7 (5.6 to 9) 0.59 The affected joint is enlarged 7 (5.6 to 8) 0.48 If you injure an area that has been affected by gout, it takes longer to heal than one that has not been affected by gout* 7 (5 to 9) 0.75 Only one foot is usually affected at a time 7 (5 to 9) 0.75 The pain is still present even when the affected joint is not being moved/used 7 (5 to 9) 0.75 There is a burning feeling in the affected area 7 (4.6 to 8.4) 0.83 Items agreed to be uncertain An attack of gout often occurs after eating red meat* 6 (5.4 to 7.2) 0.42 An increase in blood pressure may be observed* 5 (5 to 7.8) 0.63 Other members of your family have/have had gout* 5 (5 to 6.6) 0.45 The duration of an attack of gout is relatively short (1–2 days)* 5 (4.4 to 6.6) 0.71 Items agreed to be not discriminatory The affected joints appear deformed/have changed shape* 3 (2.4 to 5) 0.6 The elbows are affected* 3 (1.8 to 5) 0.67 The ball of the foot is affected* 3 (1.4 to 5.6) 0.91 The fingers are affected* 3 (1.4 to 4.2) 0.5 An attack of gout often occurs after eating asparagus 3 (1 to 5) 0.75 The knees are affected* 3 (1 to 4.2) 0.54 The pain is always present in the hands — even in the absence of an attack of gout 1 (1 to 5) 0.75 Items for which there was disagreement The pain may produce depression* 7 (4 to 9) 1.09 The joints in the top of the foot are affected* 4 (2.4 to 6.2) 1.12 White lumps are observed on the fingers* 5 (3.8 to 8) 1.14 The area around the affected joint is swollen* 8 (3.8 to 9) 1.17 The pain is worse when you move the affected joint* 5 (3.4 to 8.6) 1.35 When these lumps are lanced they release a white substance* 1 (1 to 6.8) 1.45 Friction/rubbing makes the affected joint more painful* 5 (1.8 to 6.8) 1.47 The attack resolves quickly* 5 (2.4 to 7) 1.64 The affected joint is stiff* 3 (1.8 to 7.6) 2.07 The ankles are affected* 5 (2.4 to 7.6) 2.21
