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EULAR Recommendations for the Diagnosis of Acute Gout

Purpose: To identify a patient with gout based on the EULAR recommendations.

Description

The European League Against Rheumatism (EULAR) Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT) made recommendations for the diagnosis and management of gout. These included clinical and laboratory findings useful in making the diagnosis.


 

Criteria

Modifier

LR

rapid onset of pain and swelling reaching maximum within 6 to 12 hours

 

1.3

erythema

 

2.4

podegra (gouty pain in great toe)

 

30.6

tophi

definite

40

tophi

possible

34

hyperuricemia

 

9.7

asymmetric swelling on radiographs

 

4.1

subcortical cysts without erosions on radiographs

 

6.4

presence of uric acid crystals

acute

567

presence of uric acid crystals

between attacks

15.1

from Table 4, page 1304

 

where:

• LR = likelihood ratio

• A patient may experience gout with a normal serum uric acid concentration.

• The likelihood ratio for uric acid crystals during the interictal period seems low.

• The identification of uric acid crystals is affected by a number of factors including the skill of the observer.

 

post-test probability of gout =

= (pre-test probability) * CUMULATIVE PRODUCT (LR for criteria present)


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Specialty

Objective

ICD-10