How to Differentiate Gout, Calcium Pyrophosphate Deposition Disease, and Osteoarthritis Using Just Four Clinical Parameters.

Dmitrij Kravchenko,Charlotte Behning,Valentin Schäfer,Raoul Bergner

doi:10.3390/diagnostics11060924

Abstract

Clinical differentiation between gout, osteoarthritis (OA), and calcium pyrophosphate deposition disease (CPPD) remains a hurdle in daily practice without imaging or arthrocentesis. We performed a retrospective analysis of consecutive patients with gout, CPPD, and OA at a tertiary rheumatology center. A total of 277 patients were enrolled, with 164 suffering from gout, 76 from CPPD, and 37 from OA. We used ANOVA and conditional inference tree analysis (Ctrees) to find associations between clinical, laboratory, and imaging data and gout, OA, and CPPD. The sonographic double contour sign was unable to differentiate gout from CPPD. Ctrees were able to exclude OA and CPPD as possible differentials based on elevated uric acid, C-reactive protein (CRP), presence of arterial hypertension, and sex, diagnosing gout with a sensitivity and specificity of 95.1% and 41.6%, respectively. Elevated CRP was observed using simple linear regressions in patients with type II diabetes, higher cumulative joint scores, increased number of affected joints, as well as elevated uric acid, erythrocyte sedimentation rate, and leukocyte count. Ctrees were able to differentiate gout, OA, and CPPD based on just four characteristics. Inflammatory response correlated with type II diabetes, more or larger joint involvement, and elevated uric acid levels.

Highlights

The differentiation between inflammatory osteoarthritis (OA), the most common type of arthropathy, and gout, the most prevalent crystal arthropathy, is often difficult in daily clinical practice without laboratory tests, imaging, or arthrocentesis [1]
Osteoarthritis is commonly defined as a heterogeneous group of conditions that lead to arthralgia [2]
164 patients suffering from gout, 37 from OA, and 76 from calcium pyrophosphate deposition disease (CPPD) were included into our study

Summary

Introduction

The differentiation between inflammatory osteoarthritis (OA), the most common type of arthropathy, and gout, the most prevalent crystal arthropathy, is often difficult in daily clinical practice without laboratory tests, imaging, or arthrocentesis [1]. Diagnostic criteria are divided into clinically defined OA and radiographically defined OA. Clinical diagnostic criteria are based on symptoms and signs on physical examination, while radiographically defined OA relies on the Kellgren–Lawrence scale [3]. This scale classifies OA according to formation of osteophytes, periarticular ossicles, narrowing of joint space associated with sclerosis of subchondral bone, small pseudocystic areas with sclerotic walls, and altered shape of bone ends [4]. Ultrasound allows the detection of a wide spectrum of pathologic findings indicative of OA, involving articular cartilage, bony cortex, and synovial tissue [5]

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