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2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative
  1. Tuhina Neogi1,
  2. Tim L Th A Jansen2,3,
  3. Nicola Dalbeth4,
  4. Jaap Fransen3,
  5. H Ralph Schumacher5,
  6. Dianne Berendsen3,
  7. Melanie Brown6,
  8. Hyon Choi1,
  9. N Lawrence Edwards7,
  10. Hein J E M Janssens3,
  11. Frédéric Lioté8,
  12. Raymond P Naden9,
  13. George Nuki10,
  14. Alexis Ogdie5,
  15. Fernando Perez-Ruiz11,
  16. Kenneth Saag12,
  17. Jasvinder A Singh13,
  18. John S Sundy14,15,
  19. Anne-Kathrin Tausche16,
  20. Janitzia Vaquez-Mellado17,
  21. Steven A Yarows18,
  22. William J Taylor6
  1. 1Boston University School of Medicine, Boston, Massachusetts, USA
  2. 2Viecuri Medical Center, Venlo, The Netherlands
  3. 3Radboud University Medical Center, Nijmegen, The Netherlands
  4. 4University of Auckland, Auckland, New Zealand
  5. 5University of Pennsylvania, Philadelphia, Pennsylvania, USA
  6. 6University of Otago, Wellington, New Zealand
  7. 7University of Florida, Gainesville, Florida, USA
  8. 8INSERM UMR 1132, Hôpital Lariboisière, AP-HP, and Université Paris Diderot, Sorbonne Paris Cité, Paris, France
  9. 9McMaster University Medical Centre, Hamilton, Ontario, Canada
  10. 10University of Edinburgh, Edinburgh, UK
  11. 11Hospital Universitario Cruces and BioCruces Health Research Institute, Vizcaya, Spain
  12. 12University of Alabama at Birmingham, Birmingham, Alabama, USA
  13. 13Birmingham VA Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  14. 14Duke University and Duke University Medical Center, Durham, North Carolina, USA
  15. 15Gilead Sciences, Foster City, California, USA
  16. 16University Hospital Carl Gustav Carus, Dresden, Germany
  17. 17Hospital General de Mexico, Mexico City, Mexico
  18. 18University of Michigan Health System, Chelsea
  1. Correspondence to Dr Tuhina Neogi, Boston University School of Medicine, X building, Suite 200, 650 Albany Street, Boston, MA 02118, USA; tneogi{at}bu.edu

Abstract

Objective Existing criteria for the classification of gout have suboptimal sensitivity and/or specificity, and were developed at a time when advanced imaging was not available. The current effort was undertaken to develop new classification criteria for gout.

Methods An international group of investigators, supported by the American College of Rheumatology and the European League Against Rheumatism, conducted a systematic review of the literature on advanced imaging of gout, a diagnostic study in which the presence of monosodium urate monohydrate (MSU) crystals in synovial fluid or tophus was the gold standard, a ranking exercise of paper patient cases, and a multi-criterion decision analysis exercise. These data formed the basis for developing the classification criteria, which were tested in an independent data set.

Results The entry criterion for the new classification criteria requires the occurrence of at least one episode of peripheral joint or bursal swelling, pain, or tenderness. The presence of MSU crystals in a symptomatic joint/bursa (ie, synovial fluid) or in a tophus is a sufficient criterion for classification of the subject as having gout, and does not require further scoring. The domains of the new classification criteria include clinical (pattern of joint/bursa involvement, characteristics and time course of symptomatic episodes), laboratory (serum urate, MSU-negative synovial fluid aspirate), and imaging (double-contour sign on ultrasound or urate on dual-energy CT, radiographic gout-related erosion). The sensitivity and specificity of the criteria are high (92% and 89%, respectively).

Conclusions The new classification criteria, developed using a data-driven and decision-analytic approach, have excellent performance characteristics and incorporate current state-of-the-art evidence regarding gout.

  • Gout
  • Arthritis
  • Synovial fluid

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    BMJ Publishing Group Ltd and European League Against Rheumatism