MDCalc

2015 ACR/EULAR Classification Criteria for Gout

Classification criteria for gout by ACR/EULAR.

The Acute Gout Diagnosis Rule can help rule in or rule out gout, reducing the need for synovial fluid in highly likely patients and encouraging a broad differential in gout-unlikely patients.

Entry Criterion

≥1 episode of swelling, pain, or tenderness in a peripheral joint/bursa

Sufficient Criterion

Presence of Monosodium urate (MSU) crystals in a symptomatic joint, bursa, or tophus

Classification Criteria

Clinical

Pattern of joint/bursa involvement during episodes

How many characteristics during episode(s)?

Erythema overlying joint (reported or observed); can't bear touch or pressure to joint; great difficulty with walking or inability to use joint.

How many episodes with the following time-course?

≥2 time course symptoms, regardless of anti-inflammatory use: (1) Time to maximal pain <24 hours; (2) Resolution of symptoms in ≤14 days; (3) Complete resolution (to baseline level) between symptomatic episodes.

Evidence of tophus

See Evidence for more details.

Laboratory

Serum Urate

See Evidence for more details.

Synovial fluid analysis of a symptomatic (ever) joint or bursa

See Evidence for more details.

Imaging

Imaging evidence of urate deposition in symptomatic joint/bursa

See Evidence for more details.

Imaging evidence of gout-related joint damage

See Evidence for more details.

Result:

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Advice
  • Gout flares are often treated with some combination of steroids, NSAIDS (classically, indomethacin), opioids for extreme pain, and colchicine, depending on a patient's age and other risk factors for complications.
  • After the initial flare, patients may benefit from urate-lowering therapies like allopurinol.
Management

Other causes of monoarthritis should be considered if patient does not meet criteria for gout, for example: pseudogout, septic arthritis, reactive arthritis, psoriatic, rheumatoid, or osteoarthritis.

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