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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
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    Acute Gout Diagnosis Rule

    Risk stratifies for gout vs non-gout arthritis and helps determine which patients benefit most from joint aspiration.
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    Why Use

    A patient with a new monoarthritis.

    • The Acute Gout Diagnosis Rule helps reduce unnecessary joint aspirations by predicting gout risk based on clinical criteria.
    • It was originally studied and validated in two primary care cohorts in Europe, so may not be as applicable in non-European populations.
    • Score correlates with likelihood of gout, with scores ≤4 unlikely to be gout, scores ≥8 likely to be gout, and 4-8 indeterminate.
    • False positives in the studies were mostly “unknown arthritis” and management typically did not change. Septic arthritis was not seen in these high scores.
    • Low scores are unlikely to be gout and other causes of gout should be considered, including pseudogout, septic arthritis, reactive arthritis, psoriatic, rheumatoid, or osteoarthritis.
    • The Acute Gout Diagnosis Rule can help rule in or rule out the diagnosis of gout, and help determine which patients benefit from joint aspiration and which could be treated empirically for gout specifically.
    • The rule also out-performs clinician gestalt and improves diagnostic accuracy.
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    +2
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    +0.5
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    +2.5
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    +3.5

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    Evidence
    Creator Insights

    Advice

    The authors provide several recommendations based on a patient's score:

    • ≤4 points: Unlikely gout. Other causes of monoarthritis should be considered, for example: pseudogout, septic arthritis, reactive arthritis, psoriatic, rheumatoid, or osteoarthritis.
    • 4-8 points: These patients are most likely to benefit from joint aspiration and fluid analysis for urate crystals.
    • ≥8 points: Gouty arthritis is very likely, and empiric gout medications can be started as opposed to more generic arthritis treatments (like NSAIDs).

    Management

    • 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.
    About the Creator
    Dr. Hein Janssens
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