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Gout diagnoses uncertain when made by general practitioners without serum uric acid testing: an observational study
Hein Janssens1, Lisanne Houtappels2,3, Tjard Schermer2,4
1Department of Primary and Community Care, Radboudumc Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands. hein.janssens@radboudumc.nl.
Clinical Rheumatology
|October 29, 2024
Summary
General practitioners (GPs) often diagnose gout without testing serum uric acid (SUA). This practice leads to significant diagnostic uncertainty, impacting patient care and research accuracy.
Area of Science:
- Rheumatology
- Primary Care Medicine
- Diagnostic Accuracy
Background:
- General practitioners (GPs) manage the majority of gout diagnoses, relying heavily on clinical assessment.
- Serum uric acid (SUA) levels above 0.35 mmol/L are a key determinant in the clinical diagnosis of gout.
- The extent to which GPs utilize SUA testing for initial gout diagnoses is not well-established.
Purpose of the Study:
- To evaluate the frequency of serum uric acid (SUA) testing by GPs during the initial diagnosis of gout.
- To assess the impact of not performing SUA tests on the certainty of gout diagnoses.
- To identify consequences for clinical care and research involving primary care patients with gout.
Main Methods:
- Retrospective analysis of 7782 patients from 87 Dutch general practices between 2013 and 2022.
- Calculated the proportion of patients with a first gout diagnosis and a recorded SUA test.
- Assessed the timing of SUA testing relative to diagnosis, SUA levels, and concordance with the 'Acute Gout Diagnosis Rule' (AGD-rule).
Main Results:
- In 43.0% of cases, no serum uric acid (SUA) test result was recorded at the time of gout diagnosis.
- When SUA levels >0.35 mmol/L were documented and timely, gout was highly likely ('Gout very likely' by AGD-rule) in most patients.
- Absence of timely, elevated SUA testing resulted in 'Questionable or indeterminate gout diagnosis' or even alternative arthritis diagnoses, particularly in females.
Conclusions:
- Approximately 40% of gout diagnoses by GPs lack serum uric acid (SUA) testing, creating avoidable diagnostic uncertainty.
- This diagnostic uncertainty affects clinical management and introduces potential inaccuracies in research studies including primary care gout patients.
- Emphasizes the need for GPs to consistently perform SUA testing for definitive gout diagnosis and for researchers to account for diagnostic ambiguity in primary care data.
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