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preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng219er3-lrg.png" alt="Cover of Evidence reviews for what are the most accurate and cost-effective approaches to diagnosing gout, in particular serum urate level compared with joint aspiration?" /></a></div><div class="bkr_bib"><h1 id="_NBK583528_"><span itemprop="name">Evidence reviews for what are the most accurate and cost-effective approaches to diagnosing gout, in particular serum urate level compared with joint aspiration?</span></h1><div class="subtitle">Gout: diagnosis and management</div><p><b>Evidence review C</b></p><p><i>NICE Guideline, No. 219</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2022 Jun</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-4603-7</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div></div><div class="bkr_clear"></div></div><div id="niceng219er3.s1"><h2 id="_niceng219er3_s1_">1. Approaches to diagnosing gout</h2><div id="niceng219er3.s1.1"><h3>1.1. Review question: What are the most accurate and cost-effective approaches to diagnosing gout, in particular serum urate level compared with joint aspiration?</h3><div id="niceng219er3.s1.1.1"><h4>1.1.1. Introduction</h4><p>In the UK, 95-99% of people with gout have their diagnosis made in primary care following an acute presentation via a detailed history and examination of the affected joint(s). Clinical diagnosis is subsequently confirmed with the use of a clinical investigation.</p><p>Currently, the investigation of choice in primary care is a serum urate level. Where there is diagnostic uncertainty, a person may be referred to rheumatology services, where in addition to serum urate levels, joint aspiration and other diagnostic imaging investigations are more likely to be performed. This evidence review evaluates the diagnostic accuracy of the different approaches to diagnosing gout.</p></div><div id="niceng219er3.s1.1.2"><h4>1.1.2. Summary of the protocol</h4><p>For full details see the review protocol in <a href="#niceng219er3.appa">Appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er3tab1"><a href="/books/NBK583528/table/niceng219er3.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er3tab1" rid-ob="figobniceng219er3tab1"><img class="small-thumb" src="/books/NBK583528/table/niceng219er3.tab1/?report=thumb" src-large="/books/NBK583528/table/niceng219er3.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="niceng219er3.tab1"><a href="/books/NBK583528/table/niceng219er3.tab1/?report=objectonly" target="object" rid-ob="figobniceng219er3tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="niceng219er3.s1.1.3"><h4>1.1.3. Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng219er3.appa">Appendix A</a> and the <a href="/books/NBK583528/bin/methods-pdf-11132544061.pdf">methods</a> document.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng219er3.s1.1.4"><h4>1.1.4. Diagnostic evidence</h4><div id="niceng219er3.s1.1.4.1"><h5>1.1.4.1. Included studies</h5><p>A search was conducted for cross-sectional studies which assess the accuracy of diagnostic approaches for identifying gout. No studies were found for clinical assessment or serum urate level. Nine studies were included in the review. Ahmad, 2016,<a class="bibr" href="#niceng219er3.s1.1.ref1" rid="niceng219er3.s1.1.ref1"><sup>1</sup></a> Christiansen 2021,<a class="bibr" href="#niceng219er3.s1.1.ref17" rid="niceng219er3.s1.1.ref17"><sup>17</sup></a> Elsaman 2016,<a class="bibr" href="#niceng219er3.s1.1.ref24" rid="niceng219er3.s1.1.ref24"><sup>24</sup></a> Glazebrook 2011,<a class="bibr" href="#niceng219er3.s1.1.ref31" rid="niceng219er3.s1.1.ref31"><sup>31</sup></a> Lamers-Karnebeck 2014,<a class="bibr" href="#niceng219er3.s1.1.ref44" rid="niceng219er3.s1.1.ref44"><sup>44</sup></a> Loffler 2015,<a class="bibr" href="#niceng219er3.s1.1.ref50" rid="niceng219er3.s1.1.ref50"><sup>50</sup></a> Ogdie 2017,<a class="bibr" href="#niceng219er3.s1.1.ref61" rid="niceng219er3.s1.1.ref61"><sup>61</sup></a> Pattamapaspong 2017<a class="bibr" href="#niceng219er3.s1.1.ref65" rid="niceng219er3.s1.1.ref65"><sup>65</sup></a> and Singh 2021.<a class="bibr" href="#niceng219er3.s1.1.ref75" rid="niceng219er3.s1.1.ref75"><sup>75</sup></a> One study included radiography, 3 studies investigated DECT and 7 studies included ultrasound. Particular ultrasound features (images produced from the ultrasound waves) are associated with gout, such as snow-storm sign, double contour (DC) sign and tophi. The sensitivity and the specificity of the ultrasound features (determined by the individual studies) were investigated.</p><p>The studies are summarised in <a class="figpopup" href="/books/NBK583528/table/niceng219er3.tab2/?report=objectonly" target="object" rid-figpopup="figniceng219er3tab2" rid-ob="figobniceng219er3tab2">Table 2</a> below. Evidence from these studies is summarised in the clinical evidence summary below in <a class="figpopup" href="/books/NBK583528/table/niceng219er3.tab3/?report=objectonly" target="object" rid-figpopup="figniceng219er3tab3" rid-ob="figobniceng219er3tab3">Table 3</a> and references in <a href="#niceng219er3.s1.1.rl.r1">1.1.13 References</a> . The assessment of the evidence quality was conducted with emphasis on test sensitivity and specificity as this was identified by the committee as the primary measure in guiding decision-making and both being equally important. The committee set clinical decision thresholds as sensitivity/specificity of 0.8 above which a test would be recommended and 0.5 below which a test is of no clinical use.</p></div><div id="niceng219er3.s1.1.4.2"><h5>1.1.4.2. Excluded studies</h5><p>See the excluded studies list in <a href="#niceng219er3.appi">Appendix I</a>.</p></div></div><div id="niceng219er3.s1.1.5"><h4>1.1.5. Summary of studies included in the diagnostic evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er3tab2"><a href="/books/NBK583528/table/niceng219er3.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er3tab2" rid-ob="figobniceng219er3tab2"><img class="small-thumb" src="/books/NBK583528/table/niceng219er3.tab2/?report=thumb" src-large="/books/NBK583528/table/niceng219er3.tab2/?report=previmg" alt="Table 2. Summary of studies included in the evidence review." /></a><div class="icnblk_cntnt"><h4 id="niceng219er3.tab2"><a href="/books/NBK583528/table/niceng219er3.tab2/?report=objectonly" target="object" rid-ob="figobniceng219er3tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review. </p></div></div><p>See <a href="#niceng219er3.appd">Appendix D</a> for full evidence tables</p></div><div id="niceng219er3.s1.1.6"><h4>1.1.6. Summary of the diagnostic evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er3tab3"><a href="/books/NBK583528/table/niceng219er3.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er3tab3" rid-ob="figobniceng219er3tab3"><img class="small-thumb" src="/books/NBK583528/table/niceng219er3.tab3/?report=thumb" src-large="/books/NBK583528/table/niceng219er3.tab3/?report=previmg" alt="Table 3. Clinical evidence summary: diagnostic test accuracy for radiography." /></a><div class="icnblk_cntnt"><h4 id="niceng219er3.tab3"><a href="/books/NBK583528/table/niceng219er3.tab3/?report=objectonly" target="object" rid-ob="figobniceng219er3tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: diagnostic test accuracy for radiography. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er3tab4"><a href="/books/NBK583528/table/niceng219er3.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er3tab4" rid-ob="figobniceng219er3tab4"><img class="small-thumb" src="/books/NBK583528/table/niceng219er3.tab4/?report=thumb" src-large="/books/NBK583528/table/niceng219er3.tab4/?report=previmg" alt="Table 4. Clinical evidence summary: diagnostic test accuracy for dual-energy CT (DECT)." /></a><div class="icnblk_cntnt"><h4 id="niceng219er3.tab4"><a href="/books/NBK583528/table/niceng219er3.tab4/?report=objectonly" target="object" rid-ob="figobniceng219er3tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: diagnostic test accuracy for dual-energy CT (DECT). </p></div></div><p>Particular features can be detected, on the images produced by the high frequency sound waves, in order to diagnose gout with ultrasound. These features, determined by the studies, included: snowstorm (ultrasound lesions with a snowstorm appearance); double contour sign (hyperechoic linear density on the surface of the articular cartilage), tophi (tophaceous deposits with a sugar lump appearance), aggregates (hyperechoic aggregates), erosions, synovial hypertrophy (abnormal hypoechoic); doppler activity, echogenic foci (floating echogenic foci in effusion fluid). This review investigated the diagnostic accuracy of the various features, or combinations of features as the person with suspected gout may have one or a few of these features.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er3tab5"><a href="/books/NBK583528/table/niceng219er3.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er3tab5" rid-ob="figobniceng219er3tab5"><img class="small-thumb" src="/books/NBK583528/table/niceng219er3.tab5/?report=thumb" src-large="/books/NBK583528/table/niceng219er3.tab5/?report=previmg" alt="Table 5. Clinical evidence summary: diagnostic test accuracy for Ultrasound." /></a><div class="icnblk_cntnt"><h4 id="niceng219er3.tab5"><a href="/books/NBK583528/table/niceng219er3.tab5/?report=objectonly" target="object" rid-ob="figobniceng219er3tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: diagnostic test accuracy for Ultrasound. </p></div></div></div><div id="niceng219er3.s1.1.7"><h4>1.1.7. Economic evidence</h4><div id="niceng219er3.s1.1.7.1"><h5>1.1.7.1. Included studies</h5><p>No health economic studies were included.</p></div><div id="niceng219er3.s1.1.7.2"><h5>1.1.7.2. Excluded studies</h5><p>No relevant health economic studies were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#niceng219er3.appf">Appendix F</a>.</p></div></div><div id="niceng219er3.s1.1.8"><h4>1.1.8. Economic model</h4><p>This area was not prioritised for new cost-effectiveness analysis.</p></div><div id="niceng219er3.s1.1.9"><h4>1.1.9. Unit costs</h4><p>Relevant unit costs are provided below to aid consideration of cost effectiveness.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er3tab6"><a href="/books/NBK583528/table/niceng219er3.tab6/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er3tab6" rid-ob="figobniceng219er3tab6"><img class="small-thumb" src="/books/NBK583528/table/niceng219er3.tab6/?report=thumb" src-large="/books/NBK583528/table/niceng219er3.tab6/?report=previmg" alt="Table 4. Cost of diagnostic tests." /></a><div class="icnblk_cntnt"><h4 id="niceng219er3.tab6"><a href="/books/NBK583528/table/niceng219er3.tab6/?report=objectonly" target="object" rid-ob="figobniceng219er3tab6">Table 4</a></h4><p class="float-caption no_bottom_margin">Cost of diagnostic tests. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng219er3tab7"><a href="/books/NBK583528/table/niceng219er3.tab7/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figniceng219er3tab7" rid-ob="figobniceng219er3tab7"><img class="small-thumb" src="/books/NBK583528/table/niceng219er3.tab7/?report=thumb" src-large="/books/NBK583528/table/niceng219er3.tab7/?report=previmg" alt="Table 5. Cost of staff time." /></a><div class="icnblk_cntnt"><h4 id="niceng219er3.tab7"><a href="/books/NBK583528/table/niceng219er3.tab7/?report=objectonly" target="object" rid-ob="figobniceng219er3tab7">Table 5</a></h4><p class="float-caption no_bottom_margin">Cost of staff time. </p></div></div></div><div id="niceng219er3.s1.1.10"><h4>1.1.10. Evidence statements</h4><div id="niceng219er3.s1.1.10.1"><h5>Economic</h5><ul><li class="half_rhythm"><div>No relevant economic evaluations were identified.</div></li></ul></div></div><div id="niceng219er3.s1.1.11"><h4>1.1.11. The committee’s discussion and interpretation of the evidence</h4><div id="niceng219er3.s1.1.11.1"><h5>1.1.11.1. The outcomes that matter most</h5><p>The committee considered sensitivity and specificity would be the best outcomes for judging the diagnostic accuracy of the different diagnostic approaches. The committee set clinical decision thresholds as sensitivity/specificity of 0.8, above which a test would be recommended. This is because a high level of sensitivity is important to avoid people with gout being missed and not getting access to treatment. A high level of specificity is important to avoid people without gout being misdiagnosed as having it and being treated unnecessarily. This could lead to people without gout taking medications, with their associated harms, for a substantial period of time. Sensitivity/specificity of 0.5 was identified as the point below which a test is of no clinical use, as the results could be due to chance.</p></div><div id="niceng219er3.s1.1.11.2"><h5>1.1.11.2. The quality of the evidence</h5><p>Only one small (n=55) study was included assessing the diagnostic accuracy of radiography, this was graded low. Three studies assessed the diagnostic accuracy of Dual energy CT (DECT), and although meta-analysed there were few participants (n=134) included. There was also inconsistency and imprecision, with an overall very low-quality grading so there was low confidence in the results. Most of the studies (n=7) included in the review assessed the accuracy of ultrasonography. A variety of signs associated with gout that could be identified by the ultrasonography were reported across the studies. These signs included DC sign, tophi, aggregates, erosions, synovial hypertrophy, doppler activity, echogenic foci, snowstorm and combinations of these. The number of signs meant the evidence was disparate. The committee thought that any of these features can be seen on ultrasound when looking for gout, however not all these features will be seen in each patient, and it is more likely to be a combination of some of them. The committee felt that studies should have looked at all of the established features for diagnosing gout on ultrasound, but most did not. The quality of the evidence assessing ultrasound varied from very low to high.</p><p>There were no studies available for clinical assessment or serum urate levels, or both combined for diagnosing gout.</p></div><div id="niceng219er3.s1.1.11.3"><h5>1.1.11.3. Benefits and harms</h5><p>There was no evidence for clinical assessment of the person with suspected gout, or for serum urate level testing or both combined. The committee considered the combination of clinical assessment and serum urate testing to be the most commonly used means of diagnosing gout, as most people with gout present to and are diagnosed in primary care.</p><p>Even though there was no evidence for the diagnostic accuracy of these, the committee agreed in their experience a combination of clinical assessment and serum urate testing is an effective and accessible method of diagnosing gout, providing that practitioners have the knowledge of the signs and symptoms to look out for. See evidence review B for further information on signs and symptoms. The committee agreed if a person presents with typical features of gout, such as rapid onset of severe pain, redness and swelling in the big toe or tophi, it would normally be unnecessary to carry out further tests other than measuring serum urate which should always be carried out to confirm hyperuricaemia. Therefore, the committee decided to recommend clinical assessment and serum urate testing initially when gout is suspected. As this is usual, good practice a research recommendation was not thought necessary.</p><p>Joint aspiration of synovial fluid analysis is considered to be the gold standard for diagnosing gout and is typically carried out when there is diagnostic uncertainty after clinical assessment and serum urate level measurement. A definitive diagnosis of gout can be made if urate crystals are observed in the synovial fluid or tophi, but this procedure is not generally indicated unless a diagnosis of gout is in doubt or infection is suspected. Joint aspiration is not a simple option and is rarely conducted in primary care because practitioners may not have the necessary expertise to carry out the procedure, and also because the samples need to be analysed quickly and protected from light to prevent deterioration. Joint aspiration of synovial fluid is therefore usually carried out in secondary care. In addition, the committee noted any decision to undertake this procedure is dependent on the joint affected, because if the affected joint is small, it may not be possible to aspirate.</p><p>Where there is uncertainty in the diagnosis after clinical assessment and urate testing, joint aspiration of synovial fluid should be undertaken to confirm or refute the diagnosis and the committee made a recommendation to reflect this. However, the committee agreed that if this was not possible, such as where the joint is too small to aspirate, then imaging modalities could be considered. There was very high specificity (1.0) for radiography (plain X-ray), with no misdiagnosis of gout when compared to those identified by joint aspiration of synovial fluid. However, the sensitivity was low which means that many existing cases did not have radiographic features of gout and were missed. The committee acknowledged radiography is often the first choice to diagnose gout because it is easily accessible, and quick to undertake saving time in obtaining a result. However, because the sensitivity is poor this could lead to inefficiencies if a negative result would require further investigation. If radiography (plain x-ray) results are negative ultrasound is commonly used to confirm the diagnosis.</p><p>Dual energy CT (DECT) was found to be highly sensitive (0.95), and the specificity almost reached the 0.80 threshold (0.78), therefore the committee agreed this appeared a good alternative when joint aspiration of synovial fluid was not possible. However, the committee noted the quality of the evidence was very low and included only three small studies. The committee commented that there is very limited access to DECT in current practice. It is only available in secondary care and even then, access is limited due to lack of availability.</p><p>The studies assessing ultrasound reported a variety of signs associated with gout. These signs had varying sensitivity and specificity. As there were so many different signs with a range of quality the committee found this evidence difficult to interpret for the overall benefit of ultrasound in diagnosing gout. However, the committee agreed that in their experience ultrasound is useful in some settings, especially where DECT is not available. Ultrasound is more sensitive than plain X-ray. It has better diagnostic ability to confirm or refute the diagnosis. Similarly, to DECT access to joint ultrasound is limited, and typically only available in specialist MSK radiology services.</p><p>There was not an overwhelming confidence in the results or convincing case for one imaging modality over another, and in the committee’s experience some may be more available depending on the healthcare/hospital settings, therefore they agreed to recommend all as options for the diagnosis of gout.</p></div><div id="niceng219er3.s1.1.11.4"><h5>1.1.11.4. Cost effectiveness and resource use</h5><p>No economic evaluations were identified for this review question. Unit costs were presented to aid consideration of cost effectiveness.</p><p>The committee discussed the clinical evidence and unit costs presented noting no clinical evidence was identified for diagnosing gout through history and examination assessment and serum urate level testing. The committee noted than in clinical practice gout is commonly diagnosed in primary care. However, if after assessment the diagnosis remains uncertain, the person in question will be referred to rheumatology services. The committee noted that in current practice 1% - 5% of people with gout are referred to rheumatology with around 50% of these people being referred due to diagnostic uncertainty. The committee estimated that approximately two-thirds of people that are referred to rheumatology because of diagnostic uncertainty will have obtained a partial diagnosis of gout prior to referral.</p><p>Gout is typically diagnosed in general practice by taking a detailed history and physical examination and taking a serum urate level test (blood test) to measure serum urate concentrations. When there is diagnostic uncertainty joint aspiration can be undertaken. However, joint aspiration is rarely conducted in primary care because the aspirated samples need to be tested quickly and protected from light to ensure effective sample testing. In addition, in current practice, most GP practices only have samples collected once daily. Therefore, people with suspected gout need to have their joint aspirated close to the time of collections to ensure effective sample testing. Effective collection of primary care aspirated samples is also more challenging in rural settings because of the duration of time it takes for samples to reach testing facilities.</p><p>Joint aspiration is therefore more commonly performed in specialist musculoskeletal settings when the diagnosis of gout remains uncertain. The committee noted that joint aspiration is the most effective test to diagnose gout when there is diagnostic uncertainty. Therefore, upon referral to specialist settings, joint aspiration should be conducted if the affected joint is of sufficient size.</p><p>In instances where joint aspiration cannot be conducted (for example, because the affected joint is too small), or the diagnosis of gout remains uncertain, diagnostic imaging can be used to diagnose gout. X-ray can be used to detect any long-term damage in the affected joint(s) and rule out other diagnoses. The committee noted that DECT has good sensitivity and specificity to confirm or exclude a diagnosis of gout, but its availability is limited in current UK clinical practice. Ultrasound is more likely to be available, if required, to aid in the diagnosis of gout.</p><p>The recommendations made by the committee are reflective of current practice and therefore are not expected to result in a substantial resource impact.</p></div></div><div id="niceng219er3.s1.1.12"><h4>1.1.12. Recommendations supported by this evidence review</h4><p>This evidence review supports <a href="#niceng219er3.s1.1.6">recommendations 1.1.6</a> to <a href="#niceng219er3.s1.1.8">1.1.8</a>.</p></div><div id="niceng219er3.s1.1.rl.r1"><h4>1.1.13. References</h4><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref1">Ahmad
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Z, Gupta
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AK, Sharma
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R, Bhalla
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AS, Kumar
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U, Sreenivas
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V. Dual energy computed tomography: a novel technique for diagnosis of gout. International Journal of Rheumatic Diseases. 2016; 19(9):887–896 [<a href="https://pubmed.ncbi.nlm.nih.gov/27125882" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27125882</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref2">Alghamdi
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AA, Mutlaqah
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MA, Labani
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AMH, Alahmadi
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LMA, Alahmari
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AF, Albalawi
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RA
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et al. Gout management in primary care approach; Literature review. International Journal of Pharmaceutical Research and Allied Sciences. 2021; 10(1):19–23</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref3">Baer
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AN, Kurano
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T, Thakur
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UJ, Thawait
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GK, Fuld
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MK, Maynard
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JW
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et al. Dual-energy computed tomography has limited sensitivity for non-tophaceous gout: a comparison study with tophaceous gout. BMC Musculoskeletal Disorders. 2016; 17:91 [<a href="/pmc/articles/PMC4758140/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4758140</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26891750" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26891750</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref4">Bayat
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S, Baraf
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HSB, Rech
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J. Update on imaging in gout: contrasting and comparing the role of dual-energy computed tomography to traditional diagnostic and monitoring techniques. Clinical and Experimental Rheumatology. 2018; 36 (5 Suppl 114):53–60 [<a href="https://pubmed.ncbi.nlm.nih.gov/30296979" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30296979</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref5">Beecham
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J, Curtis
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L. Unit costs of health and social care 2020. Canterbury. Personal Social Services Research Unit University of Kent, 2020. Available from: <a href="https://www.pssru.ac.uk/project-pages/unit-costs/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.pssru.ac<wbr style="display:inline-block"></wbr>​.uk/project-pages/unit-costs/</a></div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref6">Bhadu
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D, Das
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SK, Wakhlu
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A, Dhakad
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U, Sharma
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M. Ultrasonographic detection of double contour sign and hyperechoic aggregates for diagnosis of gout: two sites examination is as good as six sites examination. International Journal of Rheumatic Diseases. 2018; 21(2):523–531 [<a href="https://pubmed.ncbi.nlm.nih.gov/29210196" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29210196</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref7">Bongartz
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T, Glazebrook
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KN, Kavros
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SJ, Murthy
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NS, Merry
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SP, Franz
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WB, 3rd
|
|
et al. Dual-energy CT for the diagnosis of gout: an accuracy and diagnostic yield study. Annals of the Rheumatic Diseases. 2015; 74(6):1072–1077 [<a href="/pmc/articles/PMC4431329/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4431329</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24671771" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24671771</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref8">Breuer
|
|
GS, Bogot
|
|
N, Nesher
|
|
G. Dual-energy computed tomography as a diagnostic tool for gout during intercritical periods. International Journal of Rheumatic Diseases. 2016; 19(12):1337–1341 [<a href="https://pubmed.ncbi.nlm.nih.gov/27458073" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27458073</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref9">Bussieres
|
|
AE, Peterson
|
|
C, Taylor
|
|
JAM. Diagnostic imaging guideline for musculoskeletal complaints in adults-an evidence-based approach-part 2: Upper extremity disorders. Journal of Manipulative and Physiological Therapeutics. 2008; 31(1):2–32 [<a href="https://pubmed.ncbi.nlm.nih.gov/18308152" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18308152</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref10">Cajamarca-Baron
|
|
J, Calvo Paramo
|
|
E, Manrique
|
|
JLM, Jimenez
|
|
LVV, Sarmiento-Monroy
|
|
JC, Rojas-Villarraga
|
|
A. The use of digital tomosynthesis in rheumatology: a systematic review of the literature focused on four diseases. Radiologia. 2021; 63(2):127–144 [<a href="https://pubmed.ncbi.nlm.nih.gov/33451719" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33451719</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref11">Carotti
|
|
M, Salaffi
|
|
F, Filippucci
|
|
E, Aringhieri
|
|
G, Bruno
|
|
F, Giovine
|
|
S
|
|
et al. Clinical utility of dual energy computed tomography in gout: Current concepts and applications. Acta Bio-Medica de l Ateneo Parmense. 2020; 91(8-S):116–124 [<a href="/pmc/articles/PMC7944678/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7944678</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32945286" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32945286</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref12">Carter
|
|
JD, Kedar
|
|
RP, Anderson
|
|
SR, Osorio
|
|
AH, Albritton
|
|
NL, Gnanashanmugam
|
|
S
|
|
et al. An analysis of MRI and ultrasound imaging in patients with gout who have normal plain radiographs. Rheumatology. 2009; 48(11):1442–1446 [<a href="https://pubmed.ncbi.nlm.nih.gov/19745028" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19745028</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref13">Chen
|
|
J, Liao
|
|
M, Zhang
|
|
H, Zhu
|
|
D. Diagnostic accuracy of dual-energy CT and ultrasound in gouty arthritis : A systematic review. Zeitschrift für Rheumatologie. 2017; 76(8):723–729 [<a href="https://pubmed.ncbi.nlm.nih.gov/28058498" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28058498</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref14">Choi
|
|
IA, Kim
|
|
JH, Lee
|
|
YJ, Kang
|
|
EH, Ha
|
|
YJ, Shin
|
|
K
|
|
et al. Performance of the 2015 american college of rheumatology/european league against rheumatism classification criteria for gout in Korean patients with acute arthritis. Journal of Korean Medical Science. 2019; 34(22):e155 [<a href="/pmc/articles/PMC6556442/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6556442</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31172694" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31172694</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref15">Chou
|
|
H, Chin
|
|
TY, Peh
|
|
WC. Dual-energy CT in gout - A review of current concepts and applications. Journal of Medical Radiation Sciences. 2017; 64(1):41–51 [<a href="/pmc/articles/PMC5355369/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5355369</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28238226" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28238226</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref16">Chowalloor
|
|
PV, Keen
|
|
HI. A systematic review of ultrasonography in gout and asymptomatic hyperuricaemia. Annals of the Rheumatic Diseases. 2013; 72(5):638–645 [<a href="https://pubmed.ncbi.nlm.nih.gov/23291387" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23291387</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref17">Christiansen
|
|
SN, Ostergaard
|
|
M, Slot
|
|
O, Fana
|
|
V, Terslev
|
|
L. Ultrasound for the diagnosis of gout-the value of gout lesions as defined by the Outcome Measures in Rheumatology ultrasound group. Rheumatology. 2021; 60(1):239–249 [<a href="https://pubmed.ncbi.nlm.nih.gov/32696059" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32696059</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref18">Christiansen
|
|
SN, Ostergaard
|
|
M, Terslev
|
|
L. Ultrasonography in gout: utility in diagnosis and monitoring. Clinical and Experimental Rheumatology. 2018; 36 (5 Suppl 114):61–67 [<a href="https://pubmed.ncbi.nlm.nih.gov/30296983" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30296983</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref19">Dalbeth
|
|
N, McQueen
|
|
FM. Use of imaging to evaluate gout and other crystal deposition disorders. Current Opinion in Rheumatology. 2009; 21(2):124–131 [<a href="https://pubmed.ncbi.nlm.nih.gov/19339922" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19339922</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref20">Dalbeth
|
|
N, Schumacher
|
|
HR, Fransen
|
|
J, Neogi
|
|
T, Jansen
|
|
TL, Brown
|
|
M
|
|
et al. Survey definitions of gout for epidemiologic studies: Comparison with crystal identification as the gold standard. Arthritis Care and Research. 2016; 68(12):1894–1898 [<a href="https://pubmed.ncbi.nlm.nih.gov/27014846" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27014846</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref21">Das
|
|
S, Ghosh
|
|
A, Ghosh
|
|
P, Lahiri
|
|
D, Sinhamahapatra
|
|
P, Basu
|
|
K. Sensitivity and specificity of ultrasonographic features of gout in intercritical and chronic phase. International Journal of Rheumatic Diseases. 2017; 20(7):887–893 [<a href="https://pubmed.ncbi.nlm.nih.gov/27529533" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27529533</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref22">Dehlin
|
|
M, Landgren
|
|
AJ, Bergsten
|
|
U, Jacobsson
|
|
LTH. The validity of gout diagnosis in primary care: Results from a patient survey. Journal of Rheumatology. 2019; 46(11):1531–1534 [<a href="https://pubmed.ncbi.nlm.nih.gov/30936288" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30936288</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref23">Dehlin
|
|
M, Stasinopoulou
|
|
K, Jacobsson
|
|
L. Validity of gout diagnosis in Swedish primary and secondary care - a validation study. BMC Musculoskeletal Disorders. 2015; 16:149 [<a href="/pmc/articles/PMC4466844/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4466844</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26077041" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26077041</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref24">Elsaman
|
|
AM, Muhammad
|
|
EM, Pessler
|
|
F. Sonographic findings in gouty arthritis: Diagnostic value and association with disease duration. Ultrasound in Medicine and Biology. 2016; 42(6):1330–1336 [<a href="https://pubmed.ncbi.nlm.nih.gov/26995154" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26995154</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref25">Expert Panel on Musculoskeletal I, Jacobson
|
|
JA, Roberts
|
|
CC, Bencardino
|
|
JT, Appel
|
|
M, Arnold
|
|
E
|
|
et al. ACR appropriateness criteria r chronic extremity joint pain-suspected inflammatory arthritis. Journal of the American College of Radiology. 2017; 14(5S):S81–S89 [<a href="https://pubmed.ncbi.nlm.nih.gov/28473097" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28473097</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref26">Filippucci
|
|
E, Delle Sedie
|
|
A, Riente
|
|
L, Di Geso
|
|
L, Carli
|
|
L, Ceccarelli
|
|
F
|
|
et al. Ultrasound imaging for the rheumatologist XLVII. Ultrasound of the shoulder in patients with gout and calcium pyrophosphate deposition disease. Clinical and Experimental Rheumatology. 2013; 31(5):659–664 [<a href="https://pubmed.ncbi.nlm.nih.gov/24050142" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24050142</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref27">Fodor
|
|
D, Nestorova
|
|
R, Vlad
|
|
V, Micu
|
|
M. The place of musculoskeletal ultrasonography in gout diagnosis. Medical Ultrasonography. 2014; 16(4):336–344 [<a href="https://pubmed.ncbi.nlm.nih.gov/25463888" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25463888</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref28">Gamala
|
|
M, Jacobs
|
|
JWG, Linn-Rasker
|
|
SF, Nix
|
|
M, Heggelman
|
|
BGF, Pasker-de Jong
|
|
PCM
|
|
et al. The performance of dual-energy CT in the classification criteria of gout: a prospective study in subjects with unclassified arthritis. Rheumatology. 2020; 59(4):845–851 [<a href="https://pubmed.ncbi.nlm.nih.gov/31504985" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31504985</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref29">Gamala
|
|
M, Jacobs
|
|
JWG, van Laar
|
|
JM. The diagnostic performance of dual energy CT for diagnosing gout: a systematic literature review and meta-analysis. Rheumatology. 2019; 58(12):2117–2121 [<a href="https://pubmed.ncbi.nlm.nih.gov/31089688" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31089688</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref30">Gamez-Nava
|
|
JI, Gonzalez-Lopez
|
|
L, Davis
|
|
P, Suarez-Almazor
|
|
ME. Referral and diagnosis of common rheumatic diseases by primary care physicians. British Journal of Rheumatology. 1998; 37(11):1215–1219 [<a href="https://pubmed.ncbi.nlm.nih.gov/9851272" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9851272</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref31">Glazebrook
|
|
KN, Guimaraes
|
|
LS, Murthy
|
|
NS, Black
|
|
DF, Bongartz
|
|
T, Manek
|
|
NJ
|
|
et al. Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: initial evaluation. Radiology. 2011; 261(2):516–524 [<a href="https://pubmed.ncbi.nlm.nih.gov/21926378" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21926378</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref32">Graf
|
|
SW, Whittle
|
|
SL, Wechalekar
|
|
MD, Moi
|
|
JH, Barrett
|
|
C, Hill
|
|
CL
|
|
et al. Australian and New Zealand recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion in the 3e Initiative. International Journal of Rheumatic Diseases. 2015; 18(3):341–351 [<a href="https://pubmed.ncbi.nlm.nih.gov/25884565" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25884565</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref33">Gruber
|
|
M, Bodner
|
|
G, Rath
|
|
E, Supp
|
|
G, Weber
|
|
M, Schueller-Weidekamm
|
|
C. Dual-energy computed tomography compared with ultrasound in the diagnosis of gout. Rheumatology. 2014; 53(1):173–179 [<a href="https://pubmed.ncbi.nlm.nih.gov/24136065" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24136065</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref34">Gutierrez
|
|
M, Di Geso
|
|
L, Rovisco
|
|
J, Di Carlo
|
|
M, Ariani
|
|
A, Filippucci
|
|
E
|
|
et al. Ultrasound learning curve in gout: a disease-oriented training program. Arthritis Care and Research. 2013; 65(8):1265–1274 [<a href="https://pubmed.ncbi.nlm.nih.gov/23509029" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23509029</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref35">Hu
|
|
HJ, Liao
|
|
MY, Xu
|
|
LY. Clinical utility of dual-energy CT for gout diagnosis. Clinical Imaging. 2015; 39(5):880–885 [<a href="https://pubmed.ncbi.nlm.nih.gov/25725947" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25725947</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref36">Huppertz
|
|
A, Hermann
|
|
KG, Diekhoff
|
|
T, Wagner
|
|
M, Hamm
|
|
B, Schmidt
|
|
WA. Systemic staging for urate crystal deposits with dual-energy CT and ultrasound in patients with suspected gout. Rheumatology International. 2014; 34(6):763–771 [<a href="https://pubmed.ncbi.nlm.nih.gov/24619560" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24619560</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref37">Janssens
|
|
H, Fransen
|
|
J, Janssen
|
|
M, Neogi
|
|
T, Schumacher
|
|
HR, Jansen
|
|
TL
|
|
et al. Performance of the 2015 ACR-EULAR classification criteria for gout in a primary care population presenting with monoarthritis. Rheumatology. 2017; 56(8):1335–1341 [<a href="https://pubmed.ncbi.nlm.nih.gov/28431109" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28431109</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref38">Jatuworapruk
|
|
K, Lhakum
|
|
P, Pattamapaspong
|
|
N, Kasitanon
|
|
N, Wangkaew
|
|
S, Louthrenoo
|
|
W. Performance of the existing classification criteria for gout in thai patients presenting with acute arthritis. Medicine. 2016; 95(5):e2730 [<a href="/pmc/articles/PMC4748936/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4748936</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26844519" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26844519</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref39">Jia
|
|
E, Zhu
|
|
J, Huang
|
|
W, Chen
|
|
X, Li
|
|
J. Dual-energy computed tomography has limited diagnostic sensitivity for short-term gout. Clinical Rheumatology. 2018; 37(3):773–777 [<a href="/pmc/articles/PMC5835052/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5835052</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28803339" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28803339</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref40">Juraschek
|
|
SP, Miller
|
|
ER, Wu
|
|
B, White
|
|
K, Charleston
|
|
J, Gelber
|
|
AC
|
|
et al. A randomized pilot study of dash patterned groceries on serum urate in individuals with Gout. Nutrients. 2021; 13(2):538 [<a href="/pmc/articles/PMC7914968/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7914968</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33562216" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33562216</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>41.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref41">Kravchenko
|
|
D, Bergner
|
|
R, Behning
|
|
C, Schafer
|
|
VS. How to differentiate gout, calcium pyrophosphate deposition disease, and osteoarthritis using just four clinical parameters. Diagnostics. 2021; 11(6):21 [<a href="/pmc/articles/PMC8224021/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8224021</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34063875" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34063875</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref42">Kupfer
|
|
S, Winklhofer
|
|
S, Becker
|
|
AS, Distler
|
|
O, Chung
|
|
CB, Alkadhi
|
|
H
|
|
et al. Gouty arthritis: Can we avoid unnecessary dual-energy CT examinations using prior radiographs?
|
|
PLoS ONE [Electronic Resource]. 2018; 13(7):e0200473 [<a href="/pmc/articles/PMC6039044/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6039044</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29990381" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29990381</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>43.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref43">Lai
|
|
KL, Chiu
|
|
YM. Role of ultrasonography in diagnosing gouty arthritis. Journal of Medical Ultrasound. 2011; 19(1):7–13</div></dd></dl><dl class="bkr_refwrap"><dt>44.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref44">Lamers-Karnebeek
|
|
FB, Van Riel
|
|
PL, Jansen
|
|
TL. Additive value for ultrasonographic signal in a screening algorithm for patients presenting with acute mono-/oligoarthritis in whom gout is suspected. Clinical Rheumatology. 2014; 33(4):555–559 [<a href="https://pubmed.ncbi.nlm.nih.gov/24510062" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24510062</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>45.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref45">Lee
|
|
SK, Jung
|
|
JY, Jee
|
|
WH, Lee
|
|
JJ, Park
|
|
SH. Combining non-contrast and dual-energy CT improves diagnosis of early gout. European Radiology. 2019; 29(3):1267–1275 [<a href="https://pubmed.ncbi.nlm.nih.gov/30225600" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30225600</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>46.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref46">Lee
|
|
YH, Song
|
|
GG. Diagnostic accuracy of dual-energy computed tomography in patients with gout: A meta-analysis. Seminars in Arthritis and Rheumatism. 2017; 47(1):95–101 [<a href="https://pubmed.ncbi.nlm.nih.gov/28372824" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28372824</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>47.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref47">Lee
|
|
YH, Song
|
|
GG. Diagnostic accuracy of ultrasound in patients with gout: A meta-analysis. Seminars in Arthritis and Rheumatism. 2018; 47(5):703–709 [<a href="https://pubmed.ncbi.nlm.nih.gov/29054295" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29054295</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>48.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref48">Liu
|
|
F, Chen
|
|
S, Hu
|
|
Z, Chen
|
|
J, Jiang
|
|
L, Qu
|
|
S
|
|
et al. Musculoskeletal ultrasound features-based scoring system can evaluate the severity of gout and asymptomatic hyperuricaemia. Therapeutic Advances in Musculoskeletal Disease. 2021; 13:1759720X211006985 [<a href="/pmc/articles/PMC8120533/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8120533</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34025782" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34025782</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>49.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref49">Loffler
|
|
C, Sattler
|
|
H, Loffler
|
|
U, Kramer
|
|
BK, Bergner
|
|
R. Size matters: observations regarding the sonographic double contour sign in different joint sizes in acute gouty arthritis. Zeitschrift für Rheumatologie. 2018; 77(9):815–823 [<a href="https://pubmed.ncbi.nlm.nih.gov/29536155" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29536155</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>50.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref50">Loffler
|
|
C, Sattler
|
|
H, Peters
|
|
L, Loffler
|
|
U, Uppenkamp
|
|
M, Bergner
|
|
R. Distinguishing gouty arthritis from calcium pyrophosphate disease and other arthritides. Journal of Rheumatology. 2015; 42(3):513–520 [<a href="https://pubmed.ncbi.nlm.nih.gov/25399385" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25399385</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>51.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref51">Louthrenoo
|
|
W, Jatuworapruk
|
|
K, Lhakum
|
|
P, Pattamapaspong
|
|
N. Performance of the 2015 American College of Rheumatology/European League Against Rheumatism gout classification criteria in Thai patients. Rheumatology International. 2017; 37(5):705–711 [<a href="https://pubmed.ncbi.nlm.nih.gov/28349197" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28349197</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>52.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref52">Malik
|
|
A, Schumacher
|
|
HR, Dinnella
|
|
JE, Clayburne
|
|
GM. Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis. JCR: Journal of Clinical Rheumatology. 2009; 15(1):22–24 [<a href="https://pubmed.ncbi.nlm.nih.gov/19125136" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19125136</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>53.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref53">Naredo
|
|
E, Uson
|
|
J, Jimenez-Palop
|
|
M, Martinez
|
|
A, Vicente
|
|
E, Brito
|
|
E
|
|
et al. Ultrasound-detected musculoskeletal urate crystal deposition: which joints and what findings should be assessed for diagnosing gout?
|
|
Annals of the Rheumatic Diseases. 2014; 73(8):1522–1528 [<a href="https://pubmed.ncbi.nlm.nih.gov/23709244" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23709244</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>54.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref54">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [updated October 2020]. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nice.org.uk<wbr style="display:inline-block"></wbr>​/article/PMG20/chapter<wbr style="display:inline-block"></wbr>​/1%20Introduction%20and%20overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>55.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref55">Neogi
|
|
T, Jansen
|
|
TL, Dalbeth
|
|
N, Fransen
|
|
J, Schumacher
|
|
HR, Berendsen
|
|
D
|
|
et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Annals of the Rheumatic Diseases. 2015; 74(10):1789–1798 [<a href="/pmc/articles/PMC4602275/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4602275</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26359487" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26359487</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>56.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref56">Newberry
|
|
SJ, FitzGerald
|
|
JD, Motala
|
|
A, Booth
|
|
M, Maglione
|
|
MA, Han
|
|
D
|
|
et al. Diagnosis of gout: A systematic review in support of an American college of physicians clinical practice guideline. Annals of Internal Medicine. 2017; 166(1):27–36 [<a href="https://pubmed.ncbi.nlm.nih.gov/27802505" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27802505</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>57.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref57">NHS England and NHS Improvement. National Cost Collection Data Publication 2019-2020. London. 2020. Available from: <a href="https://www.england.nhs.uk/wp-content/uploads/2021/06/National-Cost-Collection-2019-20-Report-FINAL.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.england.nhs<wbr style="display:inline-block"></wbr>​.uk/wp-content/uploads<wbr style="display:inline-block"></wbr>​/2021/06/National-Cost-Collection-2019-20-Report-FINAL<wbr style="display:inline-block"></wbr>​.pdf</a></div></dd></dl><dl class="bkr_refwrap"><dt>58.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref58">Norkuviene
|
|
E, Petraitis
|
|
M, Apanaviciene
|
|
I, Baranauskaite
|
|
A. Ultrasonographic changes in the early gout: Pooled results from the prospective controlled study. Annals of the Rheumatic Diseases. 2015; 2:1207</div></dd></dl><dl class="bkr_refwrap"><dt>59.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref59">Norkuviene
|
|
E, Petraitis
|
|
M, Apanaviciene
|
|
I, Virviciute
|
|
D, Baranauskaite
|
|
A. An optimal ultrasonographic diagnostic test for early gout: A prospective controlled study. Journal of International Medical Research. 2017; 45(4):1417–1429 [<a href="/pmc/articles/PMC5625526/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5625526</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28617199" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28617199</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>60.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref60">Notzel
|
|
A, Hermann
|
|
KG, Feist
|
|
E, Kedor
|
|
C, Ziegeler
|
|
K, Stroux
|
|
A
|
|
et al. Diagnostic accuracy of dual-energy computed tomography and joint aspiration: a prospective study in patients with suspected gouty arthritis. Clinical and Experimental Rheumatology. 2018; 36(6):1061–1067 [<a href="https://pubmed.ncbi.nlm.nih.gov/30418110" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30418110</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>61.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref61">Ogdie
|
|
A, Taylor
|
|
WJ, Neogi
|
|
T, Fransen
|
|
J, Jansen
|
|
TL, Schumacher
|
|
HR
|
|
et al. Performance of ultrasound in the diagnosis of gout in a multicenter study: Comparison with monosodium urate monohydrate crystal analysis as the gold standard. Arthritis & Rheumatology. 2017; 69(2):429–438 [<a href="/pmc/articles/PMC5278908/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5278908</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27748084" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27748084</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>62.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref62">Ogdie
|
|
A, Taylor
|
|
WJ, Weatherall
|
|
M, Fransen
|
|
J, Jansen
|
|
TL, Neogi
|
|
T
|
|
et al. Imaging modalities for the classification of gout: systematic literature review and meta-analysis. Annals of the Rheumatic Diseases. 2015; 74(10):1868–1874 [<a href="/pmc/articles/PMC4869978/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4869978</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24915980" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24915980</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>63.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref63">Ottaviani
|
|
S, Bardin
|
|
T, Richette
|
|
P. Usefulness of ultrasonography for gout. Joint, Bone, Spine: Revue du Rhumatisme. 2012; 79(5):441–445 [<a href="https://pubmed.ncbi.nlm.nih.gov/22386965" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22386965</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>64.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref64">Panwar
|
|
J, Sandhya
|
|
P, Kandagaddala
|
|
M, Nair
|
|
A, Jeyaseelan
|
|
V, Danda
|
|
D. Utility of CT imaging in differentiating sacroiliitis associated with spondyloarthritis from gouty sacroiliitis: a retrospective study. Clinical Rheumatology. 2018; 37(3):779–788 [<a href="https://pubmed.ncbi.nlm.nih.gov/29119479" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29119479</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>65.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref65">Pattamapaspong
|
|
N, Vuthiwong
|
|
W, Kanthawang
|
|
T, Louthrenoo
|
|
W. Value of ultrasonography in the diagnosis of gout in patients presenting with acute arthritis. Skeletal Radiology. 2017; 46(6):759–767 [<a href="https://pubmed.ncbi.nlm.nih.gov/28275814" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28275814</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>66.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref66">Peiteado
|
|
D, De Miguel
|
|
E, Villalba
|
|
A, Ordonez
|
|
MC, Castillo
|
|
C, Martin-Mola
|
|
E. Value of a short four-joint ultrasound test for gout diagnosis: a pilot study. Clinical and Experimental Rheumatology. 2012; 30(6):830–837 [<a href="https://pubmed.ncbi.nlm.nih.gov/23020889" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23020889</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>67.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref67">Perez-Ruiz
|
|
F, Naredo
|
|
E. Imaging modalities and monitoring measures of gout. Current Opinion in Rheumatology. 2007; 19(2):128–133 [<a href="https://pubmed.ncbi.nlm.nih.gov/17278927" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17278927</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>68.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref68">Qaseem
|
|
A, McLean
|
|
RM, Starkey
|
|
M, Forciea
|
|
MA, Denberg
|
|
TD, Barry
|
|
MJ
|
|
et al. Diagnosis of acute gout: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017; 166(1):52–57 [<a href="https://pubmed.ncbi.nlm.nih.gov/27802479" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27802479</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>69.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref69">Ramon
|
|
A, Bohm-Sigrand
|
|
A, Pottecher
|
|
P, Richette
|
|
P, Maillefert
|
|
JF, Devilliers
|
|
H
|
|
et al. Role of dual-energy CT in the diagnosis and follow-up of gout: systematic analysis of the literature. Clinical Rheumatology. 2018; 37(3):587–595 [<a href="https://pubmed.ncbi.nlm.nih.gov/29350330" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29350330</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>70.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref70">Rettenbacher
|
|
T, Ennemoser
|
|
S, Weirich
|
|
H, Ulmer
|
|
H, Hartig
|
|
F, Klotz
|
|
W
|
|
et al. Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray. European Radiology. 2008; 18(3):621–630 [<a href="https://pubmed.ncbi.nlm.nih.gov/17994238" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17994238</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>71.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref71">Robin
|
|
F, Berthoud
|
|
O, Albert
|
|
JD, Cadiou
|
|
S, Gougeon-Jolivet
|
|
A, Bendavid
|
|
C
|
|
et al. External validation of Gout-calculator performance on a cohort of acute arthritis (SYNOLACTATE) sparing distal joints such as hallux and midfoot. A cross-sectional study of 170 patients. Clinical Rheumatology. 2021; 40(5):1983–1988 [<a href="https://pubmed.ncbi.nlm.nih.gov/33113024" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33113024</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>72.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref72">Schumacher
|
|
Jr
|
|
HR, Wortmann
|
|
RL, Lewis
|
|
Jr
|
|
CS. Monosodium urate crystal deposition arthropathy part I: Review of the stages and diagnosis of gout. Advanced Studies in Medicine. 2005; 5(3):133–138</div></dd></dl><dl class="bkr_refwrap"><dt>73.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref73">Scirocco
|
|
C, Rutigliano
|
|
IM, Finucci
|
|
A, Iagnocco
|
|
A. Musculoskeletal ultrasonography in gout. Medical Ultrasonography. 2015; 17(4):535–540 [<a href="https://pubmed.ncbi.nlm.nih.gov/26649351" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26649351</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>74.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref74">Shang
|
|
J, Zhou
|
|
LP, Wang
|
|
H, Liu
|
|
B. Diagnostic performance of dual-energy ct versus ultrasonography in gout: A meta-analysis. Academic Radiology. 2020; Epub [<a href="https://pubmed.ncbi.nlm.nih.gov/32980243" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32980243</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>75.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref75">Singh
|
|
JA, Budzik
|
|
JF, Becce
|
|
F, Pascart
|
|
T. Dual-energy computed tomography versus ultrasound, alone or combined, for the diagnosis of gout: a prospective study of accuracy. Rheumatology. 2021; Epub [<a href="https://pubmed.ncbi.nlm.nih.gov/33784386" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33784386</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>76.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref76">Sivera
|
|
F, Andres
|
|
M, Falzon
|
|
L, van der Heijde
|
|
DM, Carmona
|
|
L. Diagnostic value of clinical, laboratory, and imaging findings in patients with a clinical suspicion of gout: a systematic literature review. Journal of Rheumatology - Supplement. 2014; 92:3–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/25180122" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25180122</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>77.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref77">Strobl
|
|
S, Halpern
|
|
EJ, Ellah
|
|
MA, Kremser
|
|
C, Gruber
|
|
J, Bellmann-Weiler
|
|
R
|
|
et al. Acute gouty knee arthritis: Ultrasound findings compared with dual-energy ct findings. AJR American Journal of Roentgenology. 2018; 210(6):1323–1329 [<a href="https://pubmed.ncbi.nlm.nih.gov/29702022" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29702022</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>78.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref78">Taylor
|
|
WJ, Fransen
|
|
J, Dalbeth
|
|
N, Neogi
|
|
T, Schumacher
|
|
HR, Brown
|
|
M
|
|
et al. Performance of classification criteria for gout in early and established disease. Annals of the Rheumatic Diseases. 2016; 75(1):178–182 [<a href="https://pubmed.ncbi.nlm.nih.gov/25351521" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25351521</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>79.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref79">Vazquez-Mellado
|
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J, Hernandez-Cuevas
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CB, Alvarez-Hernandez
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E, Ventura-Rios
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L, Pelaez-Ballestas
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I, Casasola-Vargas
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J
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et al. The diagnostic value of the proposal for clinical gout diagnosis (CGD). Clinical Rheumatology. 2011:1–6 [<a href="https://pubmed.ncbi.nlm.nih.gov/21979446" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21979446</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>80.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref80">Wallace
|
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SL. Hyperuricemia in the diagnosis of gout. Journal of General Internal Medicine. 1989; 4(2):178–179 [<a href="https://pubmed.ncbi.nlm.nih.gov/2651605" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2651605</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>81.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref81">Westerfield
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KL, Mounsey
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A, Nashelsky
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J. Clinical Inquiry: How do clinical prediction rules compare with joint fluid analysis in diagnosing gout?
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Journal of Family Practice. 2016; 65(11):835–847 [<a href="https://pubmed.ncbi.nlm.nih.gov/28087872" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28087872</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>82.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref82">Wright
|
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SA, Filippucci
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E, McVeigh
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C, Grey
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A, McCarron
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M, Grassi
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W
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et al. High-resolution ultrasonography of the first metatarsal phalangeal joint in gout: a controlled study. Annals of the Rheumatic Diseases. 2007; 66(7):859–864 [<a href="/pmc/articles/PMC1955124/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1955124</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/17185326" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17185326</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>83.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref83">Wu
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H, Xue
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J, Ye
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L, Zhou
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Q, Shi
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D, Xu
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R. The application of dual-energy computed tomography in the diagnosis of acute gouty arthritis. Clinical Rheumatology. 2014; 33(7):975–979 [<a href="https://pubmed.ncbi.nlm.nih.gov/24744154" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24744154</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>84.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref84">Xie
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Y, Li
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L, Luo
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R, Xu
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T, Yang
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L, Xu
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F
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et al. Diagnostic efficacy of joint ultrasonography, dual-energy computed tomography and minimally invasive arthroscopy on knee gouty arthritis, a comparative study. British Journal of Radiology. 2021; 94(1121):20200493 [<a href="/pmc/articles/PMC8506185/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8506185</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33861155" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33861155</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>85.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref85">Xue
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SW, Luo
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YK, Zhao
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YR, Jiao
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ZY. Musculoskeletal ultrasound in the differential diagnosis of gouty arthritis and rheumatoid arthritis. Pakistan Journal of Medical Sciences. 2020; 36(5):977–981 [<a href="/pmc/articles/PMC7372673/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7372673</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32704274" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32704274</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>86.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref86">Yu
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Z, Mao
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T, Xu
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Y, Li
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T, Wang
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Y, Gao
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F
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et al. Diagnostic accuracy of dual-energy CT in gout: a systematic review and meta-analysis. Skeletal Radiology. 2018; 47(12):1587–1593 [<a href="https://pubmed.ncbi.nlm.nih.gov/29725712" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29725712</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>87.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref87">Zhang
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B, Yang
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M, Wang
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H. Diagnostic value of ultrasound versus dual-energy computed tomography in patients with different stages of acute gouty arthritis. Clinical Rheumatology. 2020; 39(5):1649–1653 [<a href="https://pubmed.ncbi.nlm.nih.gov/32157468" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32157468</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>88.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref88">Zhang
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Q, Gao
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F, Sun
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W, Ma
|
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J, Cheng
|
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L, Li
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Z. The diagnostic performance of musculoskeletal ultrasound in gout: A systematic review and meta-analysis. PLoS ONE [Electronic Resource]. 2018; 13(7):e0199672 [<a href="/pmc/articles/PMC6034830/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6034830</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29979706" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29979706</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>89.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref89">Zhu
|
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L, Wu
|
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H, Wu
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X, Sun
|
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W, Zhang
|
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T, Ye
|
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L
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et al. Comparison between dual-energy computed tomography and ultrasound in the diagnosis of gout of various joints. Academic Radiology. 2015; 22(12):1497–1502 [<a href="https://pubmed.ncbi.nlm.nih.gov/26443320" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26443320</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>90.</dt><dd><div class="bk_ref" id="niceng219er3.s1.1.ref90">Zou
|
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Z, Yang
|
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M, Wang
|
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Y, Zhang
|
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B. Gout of ankle and foot: DECT versus US for crystal detection. Clinical Rheumatology. 2021; 40(4):1533–1537 [<a href="https://pubmed.ncbi.nlm.nih.gov/32880052" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32880052</span></a>]</div></dd></dl></dl></div></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng219er3.appa"><h3>Appendix A. Review protocols</h3><p id="niceng219er3.appa.et1"><a href="/books/NBK583528/bin/niceng219er3-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for approaches for diagnosing gout</a><span class="small"> (PDF, 298K)</span></p><p id="niceng219er3.appa.et2"><a href="/books/NBK583528/bin/niceng219er3-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Health economic review protocol</a><span class="small"> (PDF, 283K)</span></p></div><div id="niceng219er3.appb"><h3>Appendix B. Literature search strategies</h3><ul><li class="half_rhythm"><div>What are the most accurate and cost-effective approaches to diagnosing gout, in particular serum urate level compared with joint aspiration?</div></li></ul><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual.<a class="bibr" href="#niceng219er3.s1.1.ref54" rid="niceng219er3.s1.1.ref54"><sup>54</sup></a></p><p>For more information, please see the <a href="/books/NBK583528/bin/methods-pdf-11132544061.pdf">Methodology</a> review published as part of the accompanying documents for this guideline.</p><p id="niceng219er3.appb.et1"><a href="/books/NBK583528/bin/niceng219er3-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.1. Clinical search literature search strategy</a><span class="small"> (PDF, 305K)</span></p><p id="niceng219er3.appb.et2"><a href="/books/NBK583528/bin/niceng219er3-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.2. Health Economics literature search strategy</a><span class="small"> (PDF, 301K)</span></p></div><div id="niceng219er3.appc"><h3>Appendix C. Diagnostic evidence study selection</h3><p id="niceng219er3.appc.et1"><a href="/books/NBK583528/bin/niceng219er3-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 1. Flow chart of clinical study selection for the review of approaches for diagnosis of gout</a><span class="small"> (PDF, 252K)</span></p></div><div id="niceng219er3.appd"><h3>Appendix D. Diagnostic evidence</h3><p id="niceng219er3.appd.et1"><a href="/books/NBK583528/bin/niceng219er3-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (415K)</span></p></div><div id="niceng219er3.appe"><h3>Appendix E. Forest plots</h3><p id="niceng219er3.appe.et1"><a href="/books/NBK583528/bin/niceng219er3-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.1. Coupled sensitivity and specificity forest plots</a><span class="small"> (PDF, 373K)</span></p><p id="niceng219er3.appe.et2"><a href="/books/NBK583528/bin/niceng219er3-appe-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">E.2. ROC curves</a><span class="small"> (PDF, 305K)</span></p></div><div id="niceng219er3.appf"><h3>Appendix F. Economic evidence study selection</h3><p id="niceng219er3.appf.et1"><a href="/books/NBK583528/bin/niceng219er3-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 29. Flow chart of health economic study selection for the guideline</a><span class="small"> (PDF, 281K)</span></p></div><div id="niceng219er3.appg"><h3>Appendix G. Economic evidence tables</h3><p>None.</p></div><div id="niceng219er3.apph"><h3>Appendix H. Health economic model</h3><p>No original economic modelling was undertaken for this review question.</p></div><div id="niceng219er3.appi"><h3>Appendix I. Excluded studies</h3><div id="niceng219er3.appi.s1"><h4>Clinical studies</h4><p id="niceng219er3.appi.et1"><a href="/books/NBK583528/bin/niceng219er3-appi-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (265K)</span></p></div><div id="niceng219er3.appi.s2"><h4>Health Economic studies</h4><p>None.</p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews underpinning recommendations 1.1.7 to 1.1.9 in the NICE guideline</p><p>National Institute for Health and Care Excellence</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div><div class="small"><span class="label">Bookshelf ID: NBK583528</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/36063466" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">36063466</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng219er3tab1"><div id="niceng219er3.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583528/table/niceng219er3.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er3.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng219er3.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng219er3.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Inclusion: Adults (18 years and older) with suspected gout.</p>
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<p>Exclusion: People with calcium pyrophosphate crystal deposition, including pseudogout</p>
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</td></tr><tr><th id="hd_b_niceng219er3.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Target condition</th><td headers="hd_b_niceng219er3.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gout (including people with gout and chronic kidney disease)</td></tr><tr><th id="hd_b_niceng219er3.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Index tests</th><td headers="hd_b_niceng219er3.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Clinical assessment (history and examination)</div></li><li class="half_rhythm"><div>Serum urate level (persistently above 380 micromol/L)</div></li><li class="half_rhythm"><div>Clinical assessment plus serum urate level (history and examination plus serum urate level persistently above 380 micromol/L)</div></li><li class="half_rhythm"><div>X-ray</div></li><li class="half_rhythm"><div>Ultrasound</div></li><li class="half_rhythm"><div>Dual-energy CT (DECT)</div></li></ul>
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</td></tr><tr><th id="hd_b_niceng219er3.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard</th><td headers="hd_b_niceng219er3.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Joint aspiration (urate crystals are observed in synovial fluid or tophi)</td></tr><tr><th id="hd_b_niceng219er3.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Statistical measures</th><td headers="hd_b_niceng219er3.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Primary paired outcome:</p>
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<p>Sensitivity/specificity</p>
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</td></tr><tr><th id="hd_b_niceng219er3.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng219er3.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Diagnostic accuracy cross-sectional studies.</p>
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<p>Systematic reviews of diagnostic accuracy cross-sectional studies.</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng219er3tab2"><div id="niceng219er3.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583528/table/niceng219er3.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er3.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng219er3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng219er3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><th id="hd_h_niceng219er3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Target condition</th><th id="hd_h_niceng219er3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Index test</th><th id="hd_h_niceng219er3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard</th><th id="hd_h_niceng219er3.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ahmad 2016<a class="bibr" href="#niceng219er3.s1.1.ref1" rid="niceng219er3.s1.1.ref1"><sup>1</sup></a></td><td headers="hd_h_niceng219er3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Patients suspected of having gout</p>
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<p>N=90</p>
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<p>Age: median (range): 44 (21-75 years)</p>
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<p>Gender: 97M/ 3F</p>
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<p>Country: India</p>
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</td><td headers="hd_h_niceng219er3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gout</td><td headers="hd_h_niceng219er3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Radiographs (morphological characteristics)</p>
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<p>Dual-energy CT (DECT): gout diagnosed by a positive finding of uric acid crystals in a single joint.</p>
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<p>Bilateral feet and knees scanned.</p>
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</td><td headers="hd_h_niceng219er3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Joint aspiration of synovial fluid analysis: negatively bifringent uric acid crystals</p>
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<p>Most severely affected joint</p>
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</td><td headers="hd_h_niceng219er3.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>73% of patients were in the acute stage</p>
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<p>Also used joint aspiration plus ACR criteria as reference standard (not reported)</p>
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<p>Non-contrast CT accuracy also tested (not reported).</p>
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</td></tr><tr><td headers="hd_h_niceng219er3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Christiansen 2021<a class="bibr" href="#niceng219er3.s1.1.ref17" rid="niceng219er3.s1.1.ref17"><sup>17</sup></a></td><td headers="hd_h_niceng219er3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Clinically suspected gout</p>
|
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<p>N=82</p>
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<p>Age: mean (range): 62.4 (19-88 years)</p>
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<p>Gender: 70M/ 12F</p>
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<p>Country: Denmark</p>
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</td><td headers="hd_h_niceng219er3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gout</td><td headers="hd_h_niceng219er3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound scan (joints and tendons binarily evaluated)</td><td headers="hd_h_niceng219er3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Joint aspiration of synovial fluid analysis</td><td headers="hd_h_niceng219er3.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Also used 2015 ACR/EULAR gout classification criteria as a gold standard (not reported).</td></tr><tr><td headers="hd_h_niceng219er3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elsaman 2016<a class="bibr" href="#niceng219er3.s1.1.ref24" rid="niceng219er3.s1.1.ref24"><sup>24</sup></a></td><td headers="hd_h_niceng219er3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Patients with episodic mono or oligoarthritis</p>
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<p>N=100</p>
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<p>Age: mean (range): 53.1 (40-75 years)</p>
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<p>Gender: 55M/ 45F</p>
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<p>Country: Egypt</p>
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</td><td headers="hd_h_niceng219er3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gouty arthritis</td><td headers="hd_h_niceng219er3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound scan (Knee/ MTP joint). Diagnosis on US based on one or more of the 4 sonographic signs (echogenic foci, erosions, DC signs, tophi)</td><td headers="hd_h_niceng219er3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Joint aspiration of synovial fluid analysis (knee/ MTP joint)</td><td headers="hd_h_niceng219er3.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnosis based on number of joints, not patients.</td></tr><tr><td headers="hd_h_niceng219er3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Glazebrook 2011<a class="bibr" href="#niceng219er3.s1.1.ref31" rid="niceng219er3.s1.1.ref31"><sup>31</sup></a></td><td headers="hd_h_niceng219er3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Patients suspected of having gout</p>
|
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<p>N=94</p>
|
|
<p>Age: mean (range): 62.7 (29-89 years)</p>
|
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<p>Gender: 53M/ 41F</p>
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<p>Country: USA</p>
|
|
</td><td headers="hd_h_niceng219er3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gout</td><td headers="hd_h_niceng219er3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dual-energy CT (DECT) (most symptomatic joint)</td><td headers="hd_h_niceng219er3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Joint aspiration of synovial fluid results</td><td headers="hd_h_niceng219er3.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mainly patients with atypical presentations.</td></tr><tr><td headers="hd_h_niceng219er3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lamers-Karnebeck 2014<a class="bibr" href="#niceng219er3.s1.1.ref44" rid="niceng219er3.s1.1.ref44"><sup>44</sup></a></td><td headers="hd_h_niceng219er3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Patients with acute mono or oligoarthritis</p>
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<p>N=54</p>
|
|
<p>Age: mean (range):</p>
|
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<p>MSU proven gout group: 63.5 (55.5-69.5 years)</p>
|
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<p>Non-MSU proven gout group: 55 (41.8-63.5 years)</p>
|
|
<p>Gender:</p>
|
|
<p>MSU proven gout group: 25M/1F</p>
|
|
<p>Non-MSU proven gout group: 13M/15F</p>
|
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<p>Country: The Netherlands</p>
|
|
</td><td headers="hd_h_niceng219er3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gout/ MSU arthritis</td><td headers="hd_h_niceng219er3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound scan (performed on 6 joints: the joint with arthritis, the contralateral side, and two other joints bilaterally)</td><td headers="hd_h_niceng219er3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Joint aspiration of synovial fluid results</td><td headers="hd_h_niceng219er3.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Same observers for some index test and reference standard.</p>
|
|
<p>Included healthy joints</p>
|
|
</td></tr><tr><td headers="hd_h_niceng219er3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Loffler 2015<a class="bibr" href="#niceng219er3.s1.1.ref50" rid="niceng219er3.s1.1.ref50"><sup>50</sup></a>Loffler2015</td><td headers="hd_h_niceng219er3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Acute mono or oligoarthritis</p>
|
|
<p>N=225 joints</p>
|
|
<p>Age: mean (range): 64 (18-93 years)</p>
|
|
<p>Gender (M:F): 1.7:1</p>
|
|
<p>Country: Germany</p>
|
|
</td><td headers="hd_h_niceng219er3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gout</td><td headers="hd_h_niceng219er3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound scan (performed on the affected joint)</td><td headers="hd_h_niceng219er3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Joint aspiration of synovial fluid analysis (affected joint)</td><td headers="hd_h_niceng219er3.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Cases are joints, not patients</p>
|
|
<p>Reference standard was SF analysis according to EULAR recommendations</p>
|
|
</td></tr><tr><td headers="hd_h_niceng219er3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ogdie 2017<a class="bibr" href="#niceng219er3.s1.1.ref61" rid="niceng219er3.s1.1.ref61"><sup>61</sup></a></td><td headers="hd_h_niceng219er3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Differential diagnosis of gout (at least 1 swollen joint)</p>
|
|
<p>N=824</p>
|
|
<p>Age: mean (SD):</p>
|
|
<p>Cases: 60.2 (14.6 years)</p>
|
|
<p>Controls: 59.5 (16.0 years)</p>
|
|
<p>Gender (male): 87% for cases, 54% for controls</p>
|
|
<p>Country: multiple countries</p>
|
|
</td><td headers="hd_h_niceng219er3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gout</td><td headers="hd_h_niceng219er3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound scan (performed on 1 or more clinically affected joint, most commonly knees, MTP joints and ankles)</td><td headers="hd_h_niceng219er3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Joint aspiration of synovial fluid analysis</td><td headers="hd_h_niceng219er3.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Also reports diagnostic accuracy outcomes for US findings by early/ late disease and by presence/absence of clinical tophus (not reported)</td></tr><tr><td headers="hd_h_niceng219er3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pattamapaspong 2017</td><td headers="hd_h_niceng219er3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>In-patients with acute arthritis</p>
|
|
<p>N=89</p>
|
|
<p>Age: mean (range): 65 (18-87 years)</p>
|
|
<p>Gender: 60M/ 29F</p>
|
|
<p>Country: Thailand</p>
|
|
</td><td headers="hd_h_niceng219er3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gout</td><td headers="hd_h_niceng219er3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound scan (Only the most inflamed joint was scanned)</td><td headers="hd_h_niceng219er3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Joint aspiration of synovial fluid analysis</td><td headers="hd_h_niceng219er3.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inpatient population</td></tr><tr><td headers="hd_h_niceng219er3.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Singh 2021<a class="bibr" href="#niceng219er3.s1.1.ref75" rid="niceng219er3.s1.1.ref75"><sup>75</sup></a></td><td headers="hd_h_niceng219er3.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Patients suspected of having gout/ patients being managed for gout</p>
|
|
<p>N=147 (48 had joint aspiration performed and were included in the analysis)</p>
|
|
<p>Overall cohort:</p>
|
|
<p>Age: mean (SD): 64.7 (14.3 years)</p>
|
|
<p>Gender (M:F): 127M/ 20F</p>
|
|
<p>Country: France</p>
|
|
</td><td headers="hd_h_niceng219er3.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gout</td><td headers="hd_h_niceng219er3.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Ultrasound scan (positive criteria not stated but noted ultrasound finding included DC sign and tophus as per OMERACT definitions)</p>
|
|
<p>DECT (a positive scan for gout was defined as the presence f typical colour coded MSU crystal deposits at articular or periarticular sites from a minimum threshold volume of 0.01cm3 (10mm3 or>2mm diameter)</p>
|
|
</td><td headers="hd_h_niceng219er3.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Joint aspiration of synovial fluid analysis (all knee, apart from 1 ankle and 1 metatarsophalangeal)</td><td headers="hd_h_niceng219er3.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>55/147 already had a diagnosis of gout</p>
|
|
<p>Also used 2015 ACR/EULAR gout classification criteria ≥8 as a gold standard (not reported).</p>
|
|
<p>Also reports diagnostic accuracy of DECT/US combined (either/both diagnosing gout).</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng219er3tab3"><div id="niceng219er3.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence summary: diagnostic test accuracy for radiography</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583528/table/niceng219er3.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er3.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Studies</th><th id="hd_h_niceng219er3.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No of Participants</th><th id="hd_h_niceng219er3.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of bias</th><th id="hd_h_niceng219er3.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inconsistency</th><th id="hd_h_niceng219er3.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indirectness</th><th id="hd_h_niceng219er3.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision</th><th id="hd_h_niceng219er3.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect size (95%CI)</th><th id="hd_h_niceng219er3.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_niceng219er3.tab3_1_1_1_1 hd_h_niceng219er3.tab3_1_1_1_2 hd_h_niceng219er3.tab3_1_1_1_3 hd_h_niceng219er3.tab3_1_1_1_4 hd_h_niceng219er3.tab3_1_1_1_5 hd_h_niceng219er3.tab3_1_1_1_6 hd_h_niceng219er3.tab3_1_1_1_7 hd_h_niceng219er3.tab3_1_1_1_8" id="hd_b_niceng219er3.tab3_1_1_1_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Radiography to detect gout</th></tr><tr><td headers="hd_h_niceng219er3.tab3_1_1_1_1 hd_b_niceng219er3.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab3_1_1_1_2 hd_b_niceng219er3.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">55</td><td headers="hd_h_niceng219er3.tab3_1_1_1_3 hd_b_niceng219er3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab3_1_1_1_4 hd_b_niceng219er3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab3_1_1_1_5 hd_b_niceng219er3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab3_1_1_1_6 hd_b_niceng219er3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab3_1_1_1_7 hd_b_niceng219er3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity 0.27 (0.12 to 0.46)</td><td headers="hd_h_niceng219er3.tab3_1_1_1_8 hd_b_niceng219er3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab3_1_1_1_3 hd_b_niceng219er3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab3_1_1_1_4 hd_b_niceng219er3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab3_1_1_1_5 hd_b_niceng219er3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab3_1_1_1_6 hd_b_niceng219er3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab3_1_1_1_7 hd_b_niceng219er3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity 1.00 (0.86 to 1.00)</td><td headers="hd_h_niceng219er3.tab3_1_1_1_8 hd_b_niceng219er3.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng219er3.tab3_1"><p class="no_margin">Risk of bias was assessed using the QUADAS-II checklist. Evidence quality was downgraded by 1 increment if the evidence was at high risk of bias and downgraded by 2 increments if the evidence was at very high risk of bias.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er3tab4"><div id="niceng219er3.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: diagnostic test accuracy for dual-energy CT (DECT)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583528/table/niceng219er3.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er3.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Studies</th><th id="hd_h_niceng219er3.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No of Participants</th><th id="hd_h_niceng219er3.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of bias</th><th id="hd_h_niceng219er3.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inconsistency</th><th id="hd_h_niceng219er3.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indirectness</th><th id="hd_h_niceng219er3.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision</th><th id="hd_h_niceng219er3.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect size (95%CI)</th><th id="hd_h_niceng219er3.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_niceng219er3.tab4_1_1_1_1 hd_h_niceng219er3.tab4_1_1_1_2 hd_h_niceng219er3.tab4_1_1_1_3 hd_h_niceng219er3.tab4_1_1_1_4 hd_h_niceng219er3.tab4_1_1_1_5 hd_h_niceng219er3.tab4_1_1_1_6 hd_h_niceng219er3.tab4_1_1_1_7 hd_h_niceng219er3.tab4_1_1_1_8" id="hd_b_niceng219er3.tab4_1_1_1_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">DECT to detect gout</th></tr><tr><td headers="hd_h_niceng219er3.tab4_1_1_1_1 hd_b_niceng219er3.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">3 studies</td><td headers="hd_h_niceng219er3.tab4_1_1_1_2 hd_b_niceng219er3.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">134</td><td headers="hd_h_niceng219er3.tab4_1_1_1_3 hd_b_niceng219er3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab4_1_1_1_4 hd_b_niceng219er3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>b</sup></td><td headers="hd_h_niceng219er3.tab4_1_1_1_5 hd_b_niceng219er3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab4_1_1_1_6 hd_b_niceng219er3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab4_1_1_1_7 hd_b_niceng219er3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity=0.95 (0.78-0.99)</td><td headers="hd_h_niceng219er3.tab4_1_1_1_8 hd_b_niceng219er3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab4_1_1_1_3 hd_b_niceng219er3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab4_1_1_1_4 hd_b_niceng219er3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>b</sup></td><td headers="hd_h_niceng219er3.tab4_1_1_1_5 hd_b_niceng219er3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab4_1_1_1_6 hd_b_niceng219er3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab4_1_1_1_7 hd_b_niceng219er3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity=0.78 (0.30-0.98)</td><td headers="hd_h_niceng219er3.tab4_1_1_1_8 hd_b_niceng219er3.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng219er3.tab4_1"><p class="no_margin">Risk of bias was assessed using the QUADAS-II checklist. Evidence quality was downgraded by 1 increment if the evidence was at high risk of bias and downgraded by 2 increments if the evidence was at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng219er3.tab4_2"><p class="no_margin">Inconsistency was assessed by inspection of the sensitivity and specificity forest plots, using the point estimates and confidence intervals. Particular attention was paid to values above or below 50% (diagnosis based on chance alone) and the 80% threshold set by the GC (the threshold above which would be acceptable to recommend a test). The evidence was downgraded by 1 increment if the individual studies varied across 2 areas (for example 50-80% and 80-100%) and by 2 increments if the individual studies varied across 3 areas.</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng219er3.tab4_3"><p class="no_margin">The evidence was downgraded by one increment if the 95% confidence interval crossed one clinical decision threshold and by two increments if it crossed two clinical decision thresholds. The GC set the thresholds for sensitivity and specificity as 50% (no better than chance) and 80% (threshold to recommend a test). Imprecision was assessed on confidence intervals produced by WinBUGS;</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er3tab5"><div id="niceng219er3.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: diagnostic test accuracy for Ultrasound</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583528/table/niceng219er3.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er3.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Studies</th><th id="hd_h_niceng219er3.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No of Participants</th><th id="hd_h_niceng219er3.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of bias</th><th id="hd_h_niceng219er3.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inconsistency</th><th id="hd_h_niceng219er3.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indirectness</th><th id="hd_h_niceng219er3.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision</th><th id="hd_h_niceng219er3.tab5_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect size (95%CI)</th><th id="hd_h_niceng219er3.tab5_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality</th></tr></thead><tbody><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_1_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">DC sign</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">5 studies</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1084</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.69 (0.46-0.87)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.86 (0.67-0.94)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_4_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Tophi</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">5 studies</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_4_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1082</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>b</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.49 (0.24-0.75)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>b</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.94 (0.85-0.98)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_7_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Aggregates (hyperechoic aggregates)</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_7_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">2 studies</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_7_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">171</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>b</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.58 (0.44 to 0.72)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>b</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.92 (0.78 to 0.98)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_10_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Erosions</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_10_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_10_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">82</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.77 (0.64, 0.87)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.56 (0.35, 0.76)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_13_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Synovial hypertrophy</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_13_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_13_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">82</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.98 (0.91, 1.00)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.08 (0.01, 0.26)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_13_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_16_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Doppler activity</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_16_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_16_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">82</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.81 (0.68, 0.9)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.44 (0.24, 0.65)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_16_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_19_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Diagnosis of gout</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_19_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_19_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">48</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.84 (0.69, 0.94)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.60 (0.26, 0.88)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_19_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_22_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Any abnormality (DC sign/ snowstorm/tophi)</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_22_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">2 studies</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_22_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">868</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>b</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.77 (0.73, 0.81)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.84 (0.80 to 0.88)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_22_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_25_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Snowstorm sign</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_25_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">2 studies</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_25_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">873</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.30 (0.26, 0.35)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.91 (0.88, 0.94)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_25_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_28_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">All 3 features (DC sign/ hyperechoic aggregates/ tophi)</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_28_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_28_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">89</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.17 (0.08, 0.30)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 1.00 (0.9, 1.00)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_28_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_31_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">2 features (DC sign/ snowstorm/ tophi)</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_31_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_31_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">825</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.44 (0.39, 0.49)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.95 (0.93, 0.97)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_31_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_34_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">3 features (DC sign/ snowstorm/ tophi)</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_34_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_34_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">824</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.14 (0.11, 0.18)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.98 (0.96, 0.99)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_34_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_37_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Any abnormality (DC sign/ hyperechoic aggregates/ tophus)</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_37_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_37_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">89</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.75 (0.62, 0.86)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.89 (0.74, 0.97)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_37_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_40_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Echogenic foci [joints only]</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_40_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_40_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">131 joints</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_40_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_40_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_40_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_40_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_40_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.79 (0.68, 0.88)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_40_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_40_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_40_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_40_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_40_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_40_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.65 (0.52, 0.77)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_40_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_43_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Echogenic foci + DC sign [joints only]</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_43_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_43_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">131 joints</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.34 (0.23, 0.46)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity=0.97 (0.88, 1.00)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_43_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_46_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Echogenic foci +/ or DC sign [joints only]</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_46_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_46_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">131 joints</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_46_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_46_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_46_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_46_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_46_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.86 (0.76, 0.93)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_46_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_46_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_46_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_46_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_46_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_46_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity=0.65 (0.52, 0.77)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_46_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_49_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">DC sign + doppler activity [joints only]</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_49_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_49_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">216</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_49_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_49_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_49_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_49_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_49_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.68 (0.56, 0.78)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_49_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_49_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_49_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_49_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_49_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_49_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.75 (0.67, 0.82)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_49_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_52_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">DC sign + doppler activity +SUA [joints only]</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_52_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_52_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">216</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_52_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_52_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_52_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_52_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_52_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.42 (0.31, 0.54)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_52_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_52_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_52_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_52_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_52_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_52_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.93 (0.87, 0.97)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_52_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_55_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">DC sign [joints only]</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_55_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">2 studies</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_55_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">347</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_55_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_55_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>b</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_55_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_55_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_55_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.42 (0.31, 0.55)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_55_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_55_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_55_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>b</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_55_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_55_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_55_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.97 (0.88, 1.00)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_55_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_58_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Tophi [joints only]</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_58_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_58_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">131</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_58_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_58_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_58_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_58_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_58_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.28 (0.18, 0.40)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_58_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_58_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_58_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_58_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_58_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_58_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 1.00 (0.94, 1.00)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_58_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_61_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Erosions [joints only]</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_61_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_61_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">131</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_61_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_61_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_61_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_61_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_61_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.39 (0.28, 0.52)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_61_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_61_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_61_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_61_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_61_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_61_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.62 (0.48, 0.74)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_61_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><th headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_h_niceng219er3.tab5_1_1_1_2 hd_h_niceng219er3.tab5_1_1_1_3 hd_h_niceng219er3.tab5_1_1_1_4 hd_h_niceng219er3.tab5_1_1_1_5 hd_h_niceng219er3.tab5_1_1_1_6 hd_h_niceng219er3.tab5_1_1_1_7 hd_h_niceng219er3.tab5_1_1_1_8" id="hd_b_niceng219er3.tab5_1_1_64_1" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">Diagnosis of gout [joints only]</th></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_1 hd_b_niceng219er3.tab5_1_1_64_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 study</td><td headers="hd_h_niceng219er3.tab5_1_1_1_2 hd_b_niceng219er3.tab5_1_1_64_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">131</td><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_64_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_64_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_64_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_64_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_64_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.86 (0.76, 0.93)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_64_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng219er3.tab5_1_1_1_3 hd_b_niceng219er3.tab5_1_1_64_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>a</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_4 hd_b_niceng219er3.tab5_1_1_64_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_5 hd_b_niceng219er3.tab5_1_1_64_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not serious</td><td headers="hd_h_niceng219er3.tab5_1_1_1_6 hd_b_niceng219er3.tab5_1_1_64_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">serious<sup>c</sup></td><td headers="hd_h_niceng219er3.tab5_1_1_1_7 hd_b_niceng219er3.tab5_1_1_64_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.87 (0.75, 0.94)</td><td headers="hd_h_niceng219er3.tab5_1_1_1_8 hd_b_niceng219er3.tab5_1_1_64_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng219er3.tab5_1"><p class="no_margin">Risk of bias was assessed using the QUADAS-II checklist. Evidence quality was downgraded by 1 increment if the evidence was at high risk of bias, and downgraded by 2 increments if the evidence was at very high risk of bias.</p></div></dd></dl><dl class="bkr_refwrap"><dt>B</dt><dd><div id="niceng219er3.tab5_2"><p class="no_margin">Inconsistency was assessed by inspection of the sensitivity and specificity forest plots, using the point estimates and confidence intervals. Particular attention was paid to values above or below 50% (diagnosis based on chance alone) and the 80% threshold set by the GC (the threshold above which would be acceptable to recommend a test). The evidence was downgraded by 1 increment if the individual studies varied across 2 areas (for example 50-80% and 80-100%) and by 2 increments if the individual studies varied across 3 areas.</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng219er3.tab5_3"><p class="no_margin">The evidence was downgraded by one increment if the 95% confidence interval crossed one clinical decision threshold and by two increments if it crossed two clinical decision thresholds. The GC set the thresholds for sensitivity and specificity as 50% (no better than chance) and 80% (threshold to recommend a test).Where there were 3 studies, imprecision was assessed on confidence intervals produced by WinBUGS; where there were 2 studies the results from the study with the lowest sensitivity was used.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er3tab6"><div id="niceng219er3.tab6" class="table"><h3><span class="label">Table 4</span><span class="title">Cost of diagnostic tests</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583528/table/niceng219er3.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er3.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Resource</th><th id="hd_h_niceng219er3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unit costs</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost of blood test (excluding time to take blood)<sup>(a)</sup></td><td headers="hd_h_niceng219er3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3 – £4</td></tr><tr><td headers="hd_h_niceng219er3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound scan with duration of less than 20 minutes (without contrast)</td><td headers="hd_h_niceng219er3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£63</td></tr><tr><td headers="hd_h_niceng219er3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ultrasound scan with duration of less than 20 minutes (with contrast)</td><td headers="hd_h_niceng219er3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£52</td></tr><tr><td headers="hd_h_niceng219er3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost of X-Ray</td><td headers="hd_h_niceng219er3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£34</td></tr><tr><td headers="hd_h_niceng219er3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DECT</td><td headers="hd_h_niceng219er3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No unit costs available</td></tr><tr><td headers="hd_h_niceng219er3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Joint aspiration, 19 years and over</b>
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</td><td headers="hd_h_niceng219er3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_niceng219er3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Total HRG</td><td headers="hd_h_niceng219er3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£598</td></tr><tr><td headers="hd_h_niceng219er3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Elective (FCEs<sup>(b)</sup> = 524)</td><td headers="hd_h_niceng219er3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1,439</td></tr><tr><td headers="hd_h_niceng219er3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-elective long-stay (FCEs<sup>(b)</sup> = 488)</td><td headers="hd_h_niceng219er3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1,477</td></tr><tr><td headers="hd_h_niceng219er3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-elective short-stay (FCEs<sup>(b)</sup> = 5,509)</td><td headers="hd_h_niceng219er3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£715</td></tr><tr><td headers="hd_h_niceng219er3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Day case (FCEs<sup>(b)</sup> = 6,907)</td><td headers="hd_h_niceng219er3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£846</td></tr><tr><td headers="hd_h_niceng219er3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Regular day or night admissions (FCEs<sup>(b)</sup> = 17)</td><td headers="hd_h_niceng219er3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£208</td></tr><tr><td headers="hd_h_niceng219er3.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outpatient procedures (FCEs<sup>(b)</sup> = 8,061)</td><td headers="hd_h_niceng219er3.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£219</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: NHS Reference costs 2019/20<a class="bibr" href="#niceng219er3.s1.1.ref57" rid="niceng219er3.s1.1.ref57"><sup>57</sup></a></p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng219er3.tab6_1"><p class="no_margin">Directly accessed pathology services, haematology and phlebotomy respectively</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="niceng219er3.tab6_2"><p class="no_margin">FCEs; Finished consultant episodes</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng219er3tab7"><div id="niceng219er3.tab7" class="table"><h3><span class="label">Table 5</span><span class="title">Cost of staff time</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK583528/table/niceng219er3.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng219er3.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng219er3.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Resource</th><th id="hd_h_niceng219er3.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unit costs</th></tr></thead><tbody><tr><td headers="hd_h_niceng219er3.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Primary care Practice Nurse (Band 5), cost per hour<sup>(a)</sup></td><td headers="hd_h_niceng219er3.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£42</td></tr><tr><td headers="hd_h_niceng219er3.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">General Practitioner, cost per consultation (9.22 minutes)<sup>(a)</sup></td><td headers="hd_h_niceng219er3.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£37</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: PSSRU 2020<a class="bibr" href="#niceng219er3.s1.1.ref5" rid="niceng219er3.s1.1.ref5"><sup>5</sup></a></p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng219er3.tab7_1"><p class="no_margin">Including qualification costs but excluding individual and productivity costs.</p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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