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Gout - Making a diagnosis
American College of Rheumatology criteria for the diagnosis of acute gouty arthritis
- The 'gold standard' for diagnosing gout is demonstration by microscopy of urate crystals in synovial fluid or tophi. However, testing for urate crystals in joint fluid or tophi is often not practical.
- In 1977, the American College of Rheumatology (ACR) published classification criteria for the diagnosis of acute gouty arthritis [Wallace et al, 1977]. These criteria were designed for research purposes and not specifically for use in clinical practice. The criteria supported a diagnosis of acute gouty arthritis if six or more of the following were met:
- More than one attack of acute arthritis.
- Maximal inflammation developing within 1 day of onset.
- Monoarthritis attack (90% of initial attacks are monoarticular).
- Redness over affected joint.
- Unilateral attack on the first metatarsophalangeal (big toe) joint.
- Unilateral attack on the tarsal joint.
- Tophus (proven or suspected).
- Hyperuricaemia.
- Asymmetric swelling within a joint on X-ray. Asymmetric swelling can also be found on examination, but the data from which the ACR criteria were derived did not include this.
- Subcortical cysts without erosions on X-ray.
- No organisms found on culture of synovial fluid.
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