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    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

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    Patent Pending

    ACR-EULAR Gout Classification Criteria

    Provides formal diagnostic criteria for gout.
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    INSTRUCTIONS

    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.

    When to Use
    Pearls/Pitfalls
    Why Use
    • Patients with mono or oligo-arthritis of unclear etiology where gout is in the differential diagnosis.
    • The ACR-EULAR Classification can be used to formally diagnose gout.
    • The criteria allow for a non-synovium diagnosis of gout (since presence of monosodium urate crystals in a symptomatic joint is the gold standard for gout) to assist clinicians when synovial testing is not possible (small joint, lab testing not available).
    • These criteria can substitute for synovial fluid analysis (the gold standard) if fluid analysis is not possible, or if there are sufficient other criteria that the patient meets.
    Step One - Entry Criterion
    Step Two - Sufficient Criterion
    About the Creator
    Dr. Tuhina Neogi

    Result:

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    Next Steps
    Evidence
    Creator Insights

    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 irate-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.

    Formula

    Addition of selected points.

    Evidence Appraisal

    • These criteria were developed as a consensus by leading gout experts; interestingly, the criteria were reviewed and agreed upon, then weighted and confirmed in a small set of gout patients.
      • These were then included in a validation larger cohort (the Study for Updated Gout Classification Criteria [SUGAR]).
    • The AUC for the ROC for these criteria was 0.95, with a sensitivity of 0.92 and specificity of .89. The clinical-only criteria (without other tests) AUC was 0.89.
    Dr. Tuhina Neogi

    About the Creator

    Tuhina Neogi, MD, PhD, is an associate professor at Boston University School of Medicine. She is also affiliated with the BUSPH Department of Epidemiology. Dr. Neogi’s research focuses on epidemiology and management of various musculoskeletal/rheumatic diseases, such as osteoarthritis and gout.

    To view Dr. Tuhina Neogi's publications, visit PubMed