Amir Qaseem, MD, PhD, MHA; Robert M. McLean, MD; Melissa Starkey, PhD; Mary Ann Forciea, MD; for the Clinical Guidelines Committee of the American College of Physicians (*)
Note: Clinical practice guidelines are “guides” only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP clinical practice guidelines are considered automatically withdrawn or invalid 5 years after publication or once an update has been issued.
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Disclosures: Dr. Barry reports grants and personal fees from Informed Medical Decisions Foundation and Healthwise, outside the submitted work. Dr. Boyd reports royalties from UptoDate, outside the submitted work. Dr. Manaker reports personal fees from work as a grand rounds speaker, lecturer, consultant, and expert witness on documentation, coding, billing, and reimbursement to hospitals, physicians, departments, practice groups, professional societies, insurers, and attorneys (defense, plaintiff “qui tam,” U.S. attorneys general, and the Office of the Inspector General); personal fees from work as an expert witness in workers' compensation and medical negligence; dividend income from stock held by his spouse in Pfizer and Johnson and Johnson; and meal and travel expenses for serving on the CMS Hospital Outpatient Panel, the American Medical Association/Specialty Society Relative Value Unit Update Committee, and the Board of Directors of CHEST Enterprises, a subsidiary of the American College of Chest Physicians. Authors not named here have disclosed no conflicts of interest. Authors followed the policy regarding conflicts of interest described at www.annals.org/aim/article/745942. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0569. All financial and intellectual disclosures of interest were declared, and potential conflicts were discussed and managed. No CGC members were recused from voting on this guideline due to conflicts. A record of disclosures and management of conflicts of interest is kept for each CGC meeting and conference call and can be viewed at www.acponline.org/about-acp/who-we-are/leadership/committees-boards-councils/clinical-guidelines-committee/disclosure-of-interests-for-clinical-guidelines-committee.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Qaseem and Starkey: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. McLean: Yale University School of Medicine, 46 Prince Street, New Haven, CT 06519.
Dr. Forciea: University of Pennsylvania Health System, 3615 Chestnut Street, Philadelphia, PA 19104.
Author Contributions: Conception and design: A. Qaseem, M. Starkey, M.J. Barry, N. Fitterman.
Analysis and interpretation of the data: A. Qaseem, M. Starkey, M.A. Forciea, M.J. Barry, C. Boyd, L.L. Humphrey, D. Kansagara, S. Vijan, T. Wilt.
Drafting of the article: A. Qaseem, M. Starkey, T.D. Denberg, S. Manaker.
Critical revision for important intellectual content: A. Qaseem, M. Starkey, M.A. Forciea, T.D. Denberg, M.J. Barry, C. Boyd, R.D. Chow, L.L. Humphrey, S. Manaker, S. Vijan, T. Wilt.
Final approval of the article: A. Qaseem, R. McLean, M. Starkey, M.A. Forciea, T.D. Denberg, M.J. Barry, C. Boyd, R.D. Chow, N. Fitterman, L.L. Humphrey, D. Kansagara, S. Manaker, S. Vijan, T. Wilt.
Statistical expertise: A. Qaseem.
Administrative, technical, or logistic support: A. Qaseem, M. Starkey.
Collection and assembly of data: A. Qaseem, M. Starkey.
The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the diagnosis of gout.
This guideline is based on a systematic review of published studies on gout diagnosis, identified using several databases, from database inception to February 2016. Evaluated outcomes included the accuracy of the test results; intermediate outcomes (results of laboratory and radiographic tests, such as serum urate and synovial fluid crystal analysis and radiographic or ultrasonography changes); clinical decision making (additional testing and pharmacologic or dietary management); short-term clinical (patient-centered) outcomes, such as pain and joint swelling and tenderness; and adverse effects of the tests. This guideline grades the evidence and recommendations by using the ACP grading system, which is based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method.
The target audience for this guideline includes all clinicians, and the target patient population includes adults with joint inflammation suspected to be gout.
ACP recommends that clinicians use synovial fluid analysis when clinical judgment indicates that diagnostic testing is necessary in patients with possible acute gout. (Grade: weak recommendation, low-quality evidence)
Table. The American College of Physicians' Guideline Grading System*
Summary of the American College of Physicians guideline on diagnosis of gout.
DECT = dual-energy computed tomography; MSU = monosodium urate.
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Quantum Biophysical Semeiotic Research Laboratory
November 30, 2016
Bedside diagnosing acute gout.
Today acute gout is more frequent than generally admitted. As a consequence, this facinating paper is really usefull, especially fot the GP. A 60 year-long clinical experience allows me to state that in healthy individual, the nail pressure upon the helix brings about the Gastric Aspecific Reflex (in the stomach both fundus and body dilate, while antral-pyloric region contracts) after a Latency Time of 10 seconds precisely. On the contrary, in individual involved by gout constitution, this Latency Time lowers to a number of seconds less than normal, in relation to the seriousness of underlying disorder (1-3). The suggested treatment,according to the Clinical Practice Guide Lines from the America College of Physicians has to be continued as far as the parametric values of above-referred Reflex are returned to normal.References1) Stagnaro Sergio. Biological System Functional Modification parallels Gene Mutation. www.Nature.com, March 13, 2008,http://blogs.nature.com/nm/spoonful/2008/03/gout_gene.html2) Stagnaro Sergio. Single Patient Based Medicine, Therapeutic Monitoring and proper Drugs Prescription. Nature Medicine.com. April, 4, 2008. http://blogs.nature.com/nm/spoonful/2008/04/trust_noone.html#comments3) Stagnaro S., Stagnaro-Neri M., Le Costituzioni Semeiotico-Biofisiche.Strumento clinico fondamentale per la prevenzione primaria e la definizione della Single Patient Based Medicine. Travel Factory, Roma, 2004. http://www.travelfactory.it/libro_costituzionisemeiotiche.htm
Qaseem A, McLean RM, Starkey M, Forciea MA, for the Clinical Guidelines Committee of the American College of Physicians. Diagnosis of Acute Gout: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166:52-57. doi: 10.7326/M16-0569
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Published: Ann Intern Med. 2017;166(1):52-57.
Published at www.annals.org on 1 November 2016
Gout, Guidelines, Rheumatology.
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