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Master Thesis

Performance d’un score clinico-biologique diagnostique d’arthrite goutteuse appliqué à une cohorte d’arthrites aiguës suspectes d’être septiques

Abstract : Objective: septic arthritis (SA) and gout are the main suspected etiologies in case of acute monoarthritis. Differentiating between these two etiologies is essential because SA is an emergency. The objective of this study was to investigate the performance of a gout diagnostic score developed by Janssens et al., in a cohort of acute arthritis suspected of being septic(1). Methods: This is an ancillary study of a single-center cohort of patients with suspected SA seen in the rheumatology department of the Clermont-Ferrand University Hospital, France between 2010 and 2018. Patients were classified into 3 groups according to the final diagnosis (gouty arthritis, septic arthritis or other diagnosis). The diagnostic score was calculated for each patient according to the different score parameters (male sex [2 points], previous gouty arthritis attack [2 points], onset within 24 hours [0.5 points], joint redness [1 point], involvement of the 1st metatarsophalangeal joint [2.5 points], arterial hypertension or other cardiovascular disease [1.5 points], serum uric acid > 5.88mg/dL [3.5 points]). The probability of gout was high (≥ 8), midrange (> 4 to < 8) or low (≤ 4). The performance of the score (sensitivity, specificity, positive and negative predictive value, area under the ROC curve) for the diagnosis of gouty arthritis were calculated. Results: in total, 138 patients were included, 28 (20.3% ) had gout, 42 (30.4% ) SA, 68 (49.3% ) another diagnosis. The median diagnostic score was 7 [4.5-8.75] in patients with gout, 3.5 [2.5-6] in patients with septic arthritis and 3 [2-5] in patients with another diagnosis. For a threshold of 8, the sensitivity of the score (Se) for the diagnosis of gout was 28.6% , specificity (Sp) 96.4% , positive predictive value (PPV) 66.7% , negative predictive value (NPV) 84.1% . For a threshold of 4, the score performance for gout diagnosis was: Se 82.1% , Sp 64.5% , PPV 37.1% and NPV 93.4% . The area under the ROC curve for the diagnostic score was 0.79 (95% CI: 0.70-0.88). Conclusion : The performance of the clinico-biological score of Janssens et al. for diagnosis of gout applied to a cohort of acute arthritis patients suspected of being septic was poor. Joint aspiration remains necessary to differentiate SA from another etiology.
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Master Thesis
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Submitted on : Tuesday, April 12, 2022 - 11:12:07 AM
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Aurore Lafforgue. Performance d’un score clinico-biologique diagnostique d’arthrite goutteuse appliqué à une cohorte d’arthrites aiguës suspectes d’être septiques. Médecine humaine et pathologie. 2022. ⟨dumas-03638412⟩



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