What are the diagnostic criteria for gout?

Updated: Jan 26, 2021
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

The cause of new-onset acute monoarticular arthritis cannot be reliably determined from the history and physical examination alone. Septic arthritis, gout, and pseudogout can present in very similar ways.

Nevertheless, certain clinical presentations are so characteristic of gout that attempts have been made to diagnose or exclude gout without joint aspiration. Janssens et al developed a diagnostic rule for this purpose, which included the following diagnostic criteria [100] :

  • Male sex
  • Previous arthritis attack
  • Onset within 1 day
  • Joint redness
  • First metatarsophalangeal joint involvement
  • Hypertension or 1 or more cardiovascular diseases
  • A serum uric acid level higher than 5.88 mg/dL

In a study of this rule in 328 patients, the positive predictive value of gout diagnosis by family physicians was 0.64; the negative predictive value was 0.87. [100]

Nevertheless, the criterion standards for the diagnosis of gout remain the following:

  • Demonstration of intracellular monosodium urate crystals
  • Exclusion of infection or other crystal types in the synovial fluid from the inflamed joint

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