Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Serum Procalcitonin Could Be a Useful Serologic Marker for the Differential Diagnosis Between Acute Gouty Attack and Bacterial Infection.
Choi, Sang Tae, Song, Jung-Soo
Acute gouty attack is an inflammatory condition secondary to a high concentration of uric acid in the blood. It is usually characterized by redness, tenderness, swelling and systemic or localized fever. These features and laboratory findings, including leukocytosis, elevation of serum erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels, are similar to those of infectious diseases. Moreover, there were many cases in which serum uric acid levels were not elevated in the acute gouty attack state, which made the differential diagnosis of acute gouty attack difficult. Procalcitonin is the precursor of calcitonin and increases in bacterial or fungal infection. We investigated whether or not procalcitonin levels are elevated in patients with acute gouty attack and the availability of those in differential diagnosis between acute gouty attack and bacterial infection.
This cross-sectional study included 41 patients with acute gouty attack and 75 age-matched patients with bacterial infection. The serum samples were obtained from patients during the clinically active inflammatory state. The mean duration from the development of acute gouty attack to blood sampling was 2.9 ± 2.3 days. Their serum levels of procalcitonin were measured by enzyme-linked fluorescent assay (ELFA; BioMerieux SA, France). Clinical and laboratory data were collected at the time serum samples were obtained.
Patients with acute gouty attack had significantly lower serum procalcitonin levels than the patients with bacterial infection (0.078 ± 0.066 ng/mL vs 5.401 ± 14.982 ng/mL, p= 0.003). However, there were no significant differences between these two groups in serum ESR, CRP levels, white blood cell counts and segmented neutrophil counts. The ranges of serum procalcitonin levels were from 0.05 to 0.33 ng/mL in the acute gouty attack group and from 0.05 to 102.00 ng/mL in the bacterial infection group, respectively. There was a larger number of patients in the acute gouty attack group who had serum procalcitonin levels greater than the reference range than in the bacterial infection group (11/41, 26.8 % vs 63/76, 82.9 %, p < 0.001). Serum uric acid levels were statistically elevated in patients with acute gouty attack than those without it (7.50 ± 1.89 mg/dL vs 5.02 ± 1.89 mg/dL, p < 0.001); however, the rate of patients whose serum uric acid levels were below 6.0 mg/dL was 22.0% (9/41) among the acute gouty attack group.
Serum procalcitonin levels were lower in the acute gouty attack group than in the bacterial infection group. The serum procalcitonin level could be a useful serologic marker for the differential diagnosis between acute gouty attack and bacterial infection.
To cite this abstract, please use the following information:
Choi, Sang Tae, Song, Jung-Soo; Serum Procalcitonin Could Be a Useful Serologic Marker for the Differential Diagnosis Between Acute Gouty Attack and Bacterial Infection. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :215