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Rheumatology

Gout

Classification

2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative

2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative

Entry requirement

At least 1 episode of swelling, pain, or tenderness in a peripheral joint or bursa

Sufficient criteria

Presence of MSU crystals in a symptomatic joint or bursa (ie, in synovial fluid) or tophus

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Clinical domains

Pattern of joint/bursa involvement during symptomatic episode(s) ever

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Characteristics of symptomatic episode(s) ever
  • Erythema overlying affected joint (patient-reported or physician-observed)
  • Can’t bear touch or pressure to affected joint
  • Great difficulty with walking or inability to use affected joint

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Time course of episode(s) ever
Presence (ever) of ≥2, irrespective of anti-inflammatory treatment:
  • Time to maximal pain <24 h
  • Resolution of symptoms in ≤14 days
  • Complete resolution (to baseline level) between symptomatic episodes

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Clinical evidence of tophus

Draining or chalk-like subcutaneous nodule under transparent skin, often with overlying vascularity, located in typical locations: joints, ears, olecranon bursae, finger pads, tendons (eg, Achilles)

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Laboratory domains

Serum urate:

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Synovial fluid analysis of a symptomatic (ever) joint or bursa (should be assessed by a trained observer)

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If polarizing microscopy of synovial fluid from a symptomatic (ever) joint or bursa by a trained examiner fails to show monosodium urate monohydrate (MSU) crystals, subtract 2 points. If synovial fluid was not assessed, score this item as 0.

Imaging domains

Imaging evidence of urate deposition in symptomatic (ever) joint or bursa: ultrasound evidence of double-contour sign or DECT demonstrating urate deposition

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Imaging evidence of gout-related joint damage: conventional radiography of the hands and/or feet demonstrates at least 1 erosion

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US: Hyperechoic irregular enhancement over the surface of the hyaline cartilage that is independent of the insonation angle of the ultrasound beam (note: false-positive double-contour sign [artifact] may appear at the cartilage surface but should disappear with a change in the insonation angle of the probe)

DECT: Presence of color-coded urate at articular or periarticular sites. Images should be acquired using a dual-energy computed tomography (DECT) scanner, with data acquired at 80 kV and 140 kV and analyzed using gout-specific software with a 2-material decomposition algorithm that color-codes urate.33 A positive scan is defined as the presence of color-coded urate at articular or periarticular sites. Nailbed, submillimeter, skin, motion, beam hardening, and vascular artifacts should not be interpreted as DECT evidence of urate deposition

XR: Erosion is defined as a cortical break with sclerotic margin and overhanging edge, excluding distal interphalangeal joints and gull wing appearance

Statistics

Sensitivity: 92%

Specificity: 89%

Considerations

The tool is for educational use only, is not meant to be a substitute for professional advice and should not be used for medical diagnosis and/or medical treatment.

Reference

Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJ, Lioté F, Naden RP, Nuki G, Ogdie A, Perez-Ruiz F, Saag K, Singh JA, Sundy JS, Tausche AK, Vazquez-Mellado J, Yarows SA, Taylor WJ. 2015 Gout Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol. 2015 Oct;67(10):2557-68. doi: 10.1002/art.39254. Erratum in: Arthritis Rheumatol. 2016 Feb;68(2):515. Vaquez-Mellado, Janitzia [corrected to Vazquez-Mellado, Janitzia]. PMID: 26352873; PMCID: PMC4566153.

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