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Ann Rheum Dis doi:10.1136/ard.2009.123687
  • Letter

Limited validity of the American College of Rheumatology criteria for classifying patients with gout in primary care

  1. Chris van Weel1
  1. 1Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  2. 2Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  3. 3Department of Rheumatology, Rijnstate Hospital, Arnhem, The Netherlands
  1. Correspondence to Dr Hein J E M Janssens, Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands; h.janssens{at}elg.umcn.nl
  • Accepted 1 November 2009
  • Published Online First 11 November 2009

In order to classify gout without identification of monosodium urate (MSU) crystals, the American College of Rheumatology (ACR) formulated criteria in 1977.1 Of the 11 criteria, ≥6 have to be present to classify patients as having gout. The criteria were not developed with reference to MSU crystals, nor were they tested properly afterwards against this gold standard.1,,3 However, as they are widely used and cited, testing their validity is critical to our ability to understand and treat gout.4

Many studies of gout include patients with ‘self-reported gout’, provided they fulfil the ACR criteria. Most self-reported diagnoses of gout will originate from a diagnosis made by a family physician as most patients presenting with acute gout are managed by them.2 5 This makes the primary care setting particularly relevant to test the ACR criteria.

We designed a prospective study in a Dutch primary care population (~200 000 subjects) to estimate the validity of the ACR criteria (patient recruitment 2004–6). We used identified MSU …

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