The American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) reported criteria for the diagnosis of gout.
Patient selection: >= 1 episode of swelling, pain or tenderness in a peripheral joint or bursa
Diagnostic criteria: one or both of the following
(1) presence of monosodium urate (MSU) crystals in symptomatic joint, symptomatic bursa or tophus (sufficient criterion)
(2) clinical score based on clinical, laboratory and imaging findings (below)
Clinical parameters:
(1) pattern of joint/bursa involvement during symptomatic episode(s), ever
(2) characteristics of symptomatic episodes, ever (erythema over affected joint, unable to bear touch or pressure, great difficulty with walking or unable to use affected joint)
(3) number of typical episodes (2 or 3 of the following irrespective of anti-inflammatory treatment: time to maximal pain < 24 hours; resolution <= 14 days; complete resolution between episodes)
(4) clinical evidence of tophus (subcutaneous nodule over joint, ear, olecranon bursa, finger pad, tendon, especially with chalk-like material)
Laboratory parameters:
(1) serum uric acid (uricase method)
(2) synovial fluid analysis for monosodium urate (MSU) crystals
Imaging parameters:
(1) evidence of urate deposition on symptomatic joint or bursa (double contour sign on ultrasound, dual energy computed tomography)
(2) gout-related joint damage in routine X-rays of hands and/or feet
Parameter |
Finding |
Points |
pattern of joint or bursa involvement |
none |
0 |
|
ankle or midfoot |
1 |
|
first metatarsophalangeal joint |
2 |
erythema over affected joint |
no |
0 |
|
yes |
1 |
unable to bear touch or pressure on affected joint |
no |
0 |
|
yes |
1 |
great difficulty with walking or inability use affected joint |
no |
0 |
|
yes |
1 |
number of typical episodes |
none |
0 |
|
1 |
1 |
|
2 or more, recurrent |
2 |
clinical features of tophus |
absent |
0 |
|
present |
4 |
serum uric acid |
< 4 mg/dL |
-4 |
|
4 to 5.9 mg/dL |
0 |
|
6 to 7.9 mg/dL |
2 |
|
8 to 9.9 mg/dL |
3 |
|
>= 10 mg/dL |
4 |
synovial fluid analysis |
negative |
-2 |
|
not performed |
0 |
|
positive |
sufficient criterion |
imaging findings |
absent |
0 |
|
present |
4 |
gout-related joint damage |
absent |
0 |
|
present |
4 |
subscore for clinical findings =
= SUM(points for 4 questions)
subscore for laboratory findings =
= SUM(points for 2 findings)
subscore for imaging studies =
= SUM(points for 2 findings)
total score =
= SUM(points for all 8 findings)
Interpretation:
• minimum clinical subscore: 0
• maximum clinical subscore: 11
• minimum laboratory subscore: -6
• maximum laboratory subscore: 4
• minimum imaging subscore: 0
• maximum imaging subscore: 8
• minimum total score: -6
• maximum total score: 23
• A total score >= 8 indicates gout.
Specialty: Surgery, orthopedic