Table 2Comparison of components among clinical algorithms for diagnosis of gout

ComponentsRome (1963)a16NY (1966)b16Wallace 1977
(ARA/ACR)42		EULAR 200622Janssens Diagnostic Rule 201031Clinical Gout Diagnosis (CGD) 2010413e Initiative 2014d47Richette Surveye39
Clinical characteristics
>1 attack of acute arthritis✓✓✓✓✓
Maximum inflammation developed within 1 day✓
painful joint swelling, abrupt onset, clearing 1-2 wk		✓✓✓✓✓
Monoarthritis/oligoarthritis attack✓✓
Redness observed over joints✓✓✓✓
1st MTP joint painful or swollen✓✓✓✓
podagra		✓
podagra
Unilateral 1st MTP joint attack✓✓
Unilateral tarsal joint attack✓✓
Abrupt onset and remission in 1-2 weeks initially✓
Response to colchicine – major reduction in inflammation within 48h✓✓
Pain intensity≥9/10✓
Involvement of toes, foot, or ankles✓
Treatment with corticosteroids✓
Treatment with NSAIDS✓
Resolution of pain<15 days after onset✓✓✓
Tophi (proven or suspected)✓✓✓✓✓✓✓
Radiograph
Asymmetric swelling within a joint on radiograph✓✓
Subcortical cysts without erosions on radiograph✓✓
Joint fluid
Joint fluid culture negative✓
MSU crystals in synovial fluid or tissuesf✓✓
Comorbid or risk factors
Hyperuricemia✓✓✓✓✓✓
Male sex✓✓
Hypertension or ≥1 CVD✓✓
Hypertriglyceridemia✓

3e = Evidence , Expertise, Exchange; ACR = American College of Rheumatology; ARA = Amereican Rheumatology Association; CGD = clinical gout diagnosis; CVD = cardiovascular disease; EULAR = European League Against Rheumatism; MTP = metatarsophalangeal

Note: Podagra is gout that involves the big toe.

a

Meets 2 of the following criteria.

b

MSU crystals in joint fluid or tophus or tissue OR meets 2 of the following criteria.

c

≥4/8 of the following criteria.

d

Guideline 1 states that MSU is required for a definitive diagnosis but in its absence, clinical criteria such as the following can be used or characteristic imaging findings may substitute.

e

Designed to be administered telephonically by non-physicians to assess prevalence of gout via patient self-report; treatment questions refer to most prominent episode.

f

Several algorithms specified presence of MSU crystals as definitive in lieu of other signs.

From: Results

Cover of Diagnosis of Gout
Diagnosis of Gout [Internet].
Comparative Effectiveness Reviews, No. 158.
Newberry SJ, FitzGerald J, Maglione MA, et al.
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