Synovial fluid uric acid level aids diagnosis of gout

Vaidya,Binit; Bhochhibhoya,Manisha; Nakarmi,Shweta

doi:10.3892/br.2018.1097

Synovial fluid uric acid level aids diagnosis of gout

Authors:
- Binit Vaidya
- Manisha Bhochhibhoya
- Shweta Nakarmi
View Affiliations

Affiliations: Department of Rheumatology, National Center for Rheumatic Diseases, Kathmandu 44600, Nepal, Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka‑1000, Bangladesh
Published online on: May 14, 2018 https://doi.org/10.3892/br.2018.1097
Pages: 60-64

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Examination of urate crystal in synovial fluid (SF) remains the gold standard for diagnosis of gout, but is not universally available. SF uric acid (UA) level may be measured by the uricase method with an automated analyzer. The present study aimed to evaluate the utility of SF to serum UA ratio (SSR) for diagnosis of gout. A cross‑sectional study was conducted at the National Center for Rheumatic Diseases, Nepal. Patients presenting with acute (<1 day) joint pain and/or swelling were included. Aspiration was performed in all patients and fluid was subjected to testing for urate level, pH and cell counts and microscopy. Serum samples were also assessed for urate levels, and the SSR was calculated for each patient. A receiver operating characteristic curve was plotted to determine the cutoff value for indicating diagnosis of gout. The difference in SSR between gout and non‑gout effusion was evaluated by one‑way analysis of variance. A total of 181 patients were included of which 77 had gout. The remaining cases included osteoarthritis, pseudogout, rheumatoid arthritis and ankylosing spondylitis. SSR was significantly higher in gout patients than in any other group (P<0.05). An SSR of ≥1.01 had the highest sensitivity and specificity at 89.6 and 66.3%, respectively, for identifying gout effusion. The present results indicated that SSR may be used as an aid for gout diagnosis when polarizing microscopy is not available.

View Figures

View References

1	So A: Gout in the spotlight. Arthritis Res Ther. 10:1122008. View Article : Google Scholar : PubMed/NCBI
2	Martinon F and Glimcher LH: Gout: New insights into an old disease. J Clin Invest. 116:2073–2075. 2006. View Article : Google Scholar : PubMed/NCBI
3	Currie WJ: The gout patient in general practice. Rheumatol Rehabil. 17:205–217. 1978. View Article : Google Scholar : PubMed/NCBI
4	Campion EW, Glynn RJ and DeLabry LO: Asymptomatic hyperuricemia. Risks and consequences in the Normative Aging Study. Am J Med. 82:421–426. 1987. View Article : Google Scholar : PubMed/NCBI
5	Choi HK, Mount DB and Reginato AM: American College of Physicians; American Physiological Society: Pathogenesis of gout. Ann Intern Med. 143:499–516. 2005. View Article : Google Scholar : PubMed/NCBI
6	McCarty DJ Jr, Phelps P and Pyenson J: Crystal-induced inflammation in canine joints. I. An experimental model with quantification of the host response. J Exp Med. 124:99–114. 1966. View Article : Google Scholar : PubMed/NCBI
7	Kuo CF, Grainge MJ, Zhang W and Doherty M: Global epidemiology of gout: Prevalence, incidence and risk factors. Nat Rev Rheumatol. 11:649–662. 2015. View Article : Google Scholar : PubMed/NCBI
8	Chopra A, Patil J, Billempelly V, Relwani J and Tandle HS: WHO-ILAR COPCORD Study. WHO International League of Associations from Rheumatology Community Oriented Program from Control of Rheumatic Diseases: Prevalence of rheumatic diseases in a rural population in western India: A WHO-ILAR COPCORD Study. J Assoc Physicians India. 49:240–246. 2001.PubMed/NCBI
9	Haq SA, Darmawan J, Islam MN, Uddin MZ, Das BB, Rahman F, Chowdhury MA, Alam MN, Mahmud TA, Chowdhury MR, et al: Prevalence of rheumatic diseases and associated outcomes in rural and urban communities in Bangladesh: A COPCORD study. J Rheumatol. 32:348–353. 2005.PubMed/NCBI
10	Farooqi A and Gibson T: Prevalence of the major rheumatic disorders in the adult population of north Pakistan. Br J Rheumatol. 37:491–495. 1998. View Article : Google Scholar : PubMed/NCBI
11	Ragab G, Elshahaly M and Bardin T: Gout: An old disease in new perspective - A review. J Adv Res. 8:495–511. 2017. View Article : Google Scholar : PubMed/NCBI
12	Hainer BL, Matheson E and Wilkes RT: Diagnosis, treatment, and prevention of gout. Am Fam Physician. 90:831–836. 2014.PubMed/NCBI
13	Beutler A and Schumacher HR Jr: Gout and ‘pseudogout’. When are arthritic symptoms caused by crystal deposition? Postgrad Med. 95:103–106, 109, 113–116 passim. 1994. View Article : Google Scholar
14	Schlesinger N: Diagnosis of gout. Minerva Med. 98:759–767. 2007.PubMed/NCBI
15	Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ and Yü TF: Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. 20:895–900. 1977. View Article : Google Scholar : PubMed/NCBI
16	Chen LX and Schumacher HR: Current trends in crystal identification. Curr Opin Rheumatol. 18:171–173. 2006. View Article : Google Scholar : PubMed/NCBI
17	Tsutani H, Yoshio N and Ueda T: Interleukin 6 reduces serum urate concentrations. J Rheumatol. 27:5542000.PubMed/NCBI
18	Barr WG: Uric AcidClinical Methods: The History, Physical, and Laboratory Examinations. Walker HK, Hall WD and Hurst JW: 3rd edition. Butterworths, Boston: 1990
19	Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJ, et al: 2015 Gout classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 74:1789–1798. 2015. View Article : Google Scholar : PubMed/NCBI
20	Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO III, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, et al: 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 62:2569–2581. 2010. View Article : Google Scholar : PubMed/NCBI
21	Rudwaleit M, van der Heijde D, Landewé R, Akkoc N, Brandt J, Chou CT, Dougados M, Huang F, Gu J, Kirazli Y, et al: The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 70:25–31. 2011. View Article : Google Scholar : PubMed/NCBI
22	van der Linden S, Valkenburg HA and Cats A: Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 27:361–368. 1984. View Article : Google Scholar : PubMed/NCBI
23	Montagna P, Brizzolara R, Ferrone C, Cutolo M, Paolino S and Cimmino MA: A method for counting monosodium urate crystals in synovial fluid. Reumatismo. 67:29–32. 2015. View Article : Google Scholar : PubMed/NCBI
24	Brannan SR and Jerrard DA: Synovial fluid analysis. J Emerg Med. 30:331–339. 2006. View Article : Google Scholar : PubMed/NCBI
25	Gatter RA and Schumacher HR: A Practical Handbook of Joint Fluid Analysis. 2nd edition. Lea & Febiger; Philadelphia, PA: 1991
26	Schmid K and MacNair MB: Characterization of the proteins of certain postmortem human synovial fluids. J Clin Invest. 37:708–718. 1958. View Article : Google Scholar : PubMed/NCBI
27	Schmid K and MacNair MB: Characterization of the proteins of human synovial fluid in certain disease states. J Clin Invest. 35:814–824. 1956. View Article : Google Scholar : PubMed/NCBI
28	Ruiz-Romero C, Calamia V, Carreira V, Mateos J, Fernández P and Blanco FJ: Strategies to optimize two-dimensional gel electrophoresis analysis of the human joint proteome. Talanta. 80:1552–1560. 2010. View Article : Google Scholar : PubMed/NCBI
29	Ropes MW, Bennett GA and Bauer W: The Origin and Nature of Normal Synovial Fluid. J Clin Invest. 18:351–372. 1939. View Article : Google Scholar : PubMed/NCBI
30	Beutler AM, Keenan GF, Soloway S, Norden D, Luchi M and Schumacher HR Jr: Soluble urate in sera and synovial fluids from patients with different joint disorders. Clin Exp Rheumatol. 14:249–254. 1996.PubMed/NCBI
31	Reeves B: Significance of joint fluid uric acid levels in gout. Ann Rheum Dis. 24:569–571. 1965. View Article : Google Scholar : PubMed/NCBI
32	Rozin AP, Braun-Moscovici Y and Balbir-Gurman A: Serum-synovial gradient data of normouricemic patients with history of gout and acute knee effusion. Clin Rheumatol. 25:886–888. 2006. View Article : Google Scholar : PubMed/NCBI
33	Wangkaew S, Kasitanon N, Hongsongkiat S, Tanasombat C, Sukittawut W and Louthrenoo W: A comparative study of serum and synovial fluid levels of uric acid between patients with gout and other arthritides. J Med Assoc Thai. 97:679–685. 2014.PubMed/NCBI