As a full scope family medicine provider, I frequently see patients with gout. Most of these patients already carry a diagnosis, but many do not. How do you make the proper diagnosis of gout? The “gold standard” is joint aspiration with evaluation under polarized microscopy. This process is painful for the patient, challenging to complete in a 20 minute appointment and frequently the aspiration is unsuccessful. Many patients are treated empirically which can lead to under/over diagnosis, improper treatment and exposure to dangerous side effects from gout medications such as steroids, NSAIDs and urate lowering therapies.
What if there was a better way that could completely rule-out or rule-in the diagnosis in some patients without aspiration leaving only a small proportion who require the painful and tedious aspiration procedure? In 2010, Dutch researchers, Drs Janssens, Fransen, et al., did just that through their derivation and validation of a diagnostic rule for making a proper gout diagnosis. The issue is that none of the most popular medical calculators such as MDCalc, QxCalculate, MediMath and/or MedCalc (now MedCalx)include this rule!
Dr Joshua Steinberg comes to the rescue again! He contacted the study authors and was given their permission to develop the diagnostic rule into a free medical app. For years, I have used Dr Steinberg’s many outstanding free medical apps. This past year alone he has released many medical apps that I have reviewed here on iMedicalApps including PneumoVaccines, Depo Calendar, and OB Wheels in addition to his newest app, Gout Diagnosis. Other useful point of care apps by Dr Steinberg include PreopEval14, PFT Eval, EFM Guide, PE & DVT Dx Tool, and my favorite, Pneumonia Guide. The content of the Gout Diagnosis app consists of a main screen with 5 different languages to choose from with smaller icons along the bottom for references, disclaimer, etc.. Once you choose the language from the main screen, you are taken to the main calculator screen which asks a series of seven “Yes/No” questions and outputs a score. The score ranges from 0 to 13 points and corresponds to a “very unlikely, indeterminate, or very likely” risk of having gout. Additionally, Dr Steinberg includes links to the references for the medical app and a detailed discussion on the evidence behind the calculator.
You are in clinic evaluating a male with acute onset (early this morning) of joint pain, redness in the right great toe. The patient’s past medical history is significant for hypertension and hyperuricemia with a level of 7.5 mg/dl. Does this patient have gout? Do you need to perform a joint aspiration and polarized microscopy or can you make a clinical diagnosis and treat him? Gout Diagnosis will help you with these decisions! Let’s take a look at Gout Diagnosis in action.
Evidence based medicine
Gout Diagnosis incorporates an evidence-based algorithm that was derived, and subsequently validated, to aid in the proper diagnosis of gout. The app contains numerous supporting references. Through the use of this app, providers are more likely to accurately diagnosis patients and ensure proper treatment, while sparing many the painful aspiration “gold standard” procedures to make a diagnosis. Furthermore, by using the calculator, patients may be spared potentially harmful exposures to some of the toxic side effects of gout treatments.
What providers would benefit from this App?
Students, residents, mid-levels, Family Medicine, Internal Medicine, Emergency Medicine, Rheumatologists, and any provider who cares for patients with gout.
Disclaimer: I was a beta tester for this free app and gave Dr Steinberg feedback on the content of his app. I WAS NOT compensated for this in any form. The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
- Fantastic evidence-based calculator that will change practice.
- Well-referenced with hyperlinks to PubMed.
- Available in 5 languages.
- Use of calculator output data could be more intuitive with better statistical descriptions.
- Medical app does not contain information on treatment of gout.
- Not available for Android.
Gout Diagnosis is a another simple but outstanding addition to Dr Steinberg’s growing collection free point of care medical apps. The Gout Diagnosis app has the potential to genuinely change practices in primary care (and even rheumatology clinics), by applying this valid, but not well known algorithm, to ensure a proper diagnosis of gout is made at the point of care.
- Overall Score
- User Interface
Looks like the other apps by the author meaning it is basic, but easy to use.
- Multimedia Usage
Contains links for all references in PubMed and app written in 5 different languages to ensure wide adoption.
App is free!
- Real World Applicability
An app that truly could simplify the process of making a gout diagnosis. The algorithm will eliminate the need to aspirate joint fluid from many patients, while ensuring an accurate diagnosis based on the best available evidence.
- Device Used For Review
iPhone 6S running iOS 9.3.1
- Available for DownloadiPhoneiPad