apendice loco

Hand\\ng editor 1 ore K Kvien ' Department ot Medicine, Uni'lersit)' of Auckland, Auckland, New Zealand 2Department of Medidne, Uni'lersit)' of Otago, Christchurch, New Zealand

Correspondence to Dr Nicola Dalbeth, Department of Medicine, University of

Auckland~ Private Bag 92019, 85 Park Road, Grafton, Auckland 1023, New Zealand; [email protected]

Received 27 January 2014 Revised 18 March 2014 Accepted 20 March 2014 Published Online First 9 April2014

Hyperuricaemia and gout: time for a new stagirlg system? Nko\a Dalbeth, 1 Lisa Stamp2

ABSTRACT The current widely used clinical staging system for hyperuricaemia and gout describes the symptomatology of gout, but does not capture key aspects of the pathological basis of the disease. We propose a new clinical staging system. Stage A: hyperuricaemia, but without evidence of monosodium urate (MSU) crystal deposition or symptoms of gout. Stage B: MSU crystal deposition by microscopy or advanced imaging, but without signs or symptoms of gout. Stage C: MSU crystal deposition with prior or current symptoms of acute gout flares. Stage D: advanced gout requiring specialist interventions. This proposed new staging ~em provides a clear focus on gout as a chronic disease of MSU crystal deposition, and provides a rational framework to test the role of screening and treatment of asymptomatiG ,disease.

Receivl!d evjsed 18 Matth R red 20 Matd12014 ~onllne first

9 Aprf1 2014

CrossMark

To cite: Dalbeth N, Stamp L. Ann Rheum Dis 2014;73:1598-1600.

1598

-~ . , - """ t"''V'fiUC~ Q

rational framework to test the role of screening and treatment of asymptomatic;; disease.

~te. ... ~ut;y. ar.thritis: -sustained hyperurkaemia .. leads to the ~~~t19g_,_g( MSD..,~~ll)J@:l~Qt..p~riarricular...tissues,resu.lt;rxg m ~. intennittent..self .. limiting -aeute~inflammat0ry. atitht:itis: ..

..... t.;J'!Jcnt:~l ~ut: define~- a the . p,eriQd between acut~ ~tracks . . ~e individual wilr~~~~ }1;~~~i-i~e~i~ ~drh~~ :urther attacks without treatment.

thaf'.Ki!S'UCiysta'fs' are'prese'D:r-m"many 'P'e8p1'e'Willt...,.Hfper:c.u'itaec ~~W,tbJl.Q.,.hl~ocy,. .of .flares andno ,dinical.evidencef tophi. These individuals are not captured within the current staging system. Simil~~J.n,gegplt;.-i.th, ,grior.~~t(1,/J~t~~ !W~hY.J?.P.~i_;: ~~Jlliii,-MSU.q:.ystals~ma~ be---present-.,microscopiGaily....a~. joll}ts-t.P~t"'aEe-.notmelinieallr-:inflamed-..and i.n...i9in!$ .. tJl~t ,?_ay~ -~-evef. been...._aff6cted.:.by-flares:t27 These patients may have i~~a:sing ..,. C1:~n;~top.1trtce.1Ytts; g.o.ttt\.usually occurs after gout has been

pr'esent for ffi

10 McGill synovial

11 Grassi W, gout and 2006;36:

12 Choi HK.

13

17

18

19

Contributors Both authors conceived of the paper and drafted the manuscript. Funding NO and LS are supported b th H I h (grant numbers 10/414 and 12/1 11 ). y e eat Research Council of New Zealand Competing interests ND has ~ 'ved . Savi~nt, Menorini, AstraZeneca, Ar~e~ N con~ultmg or speaker fees from Takeda, recetved consulting fees from AstraZen~ca~artts, Metabolex and Fonterra. LS has Provenance and peer review N .

at commlsstoned; externally peer reviewed.

REFERENCES t McCarty DJ, Hollander JL Id 'f' . ~~---J . ._ ~ ~--- . entt ICatton of urate rn.rtals 't

,. Y;) n aouru \ll\n\d.al fluiri

measurement 25 Klippel J. Prim

2001. 26 Pascual E. Pet

the synovial i 27 Bomalaski JS

knee joints o 1986;29:141

28 Lindsay K. a study of~ J Clin Rhe

29 Harrold l and treat (Oxford)

30 Hunt SA, Manage the Pr