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Extended report
Performance of classification criteria for gout in early and established disease
  1. William J Taylor1,
  2. Jaap Fransen2,
  3. Nicola Dalbeth3,
  4. Tuhina Neogi4,
  5. H Ralph Schumacher5,
  6. Melanie Brown1,
  7. Worawit Louthrenoo6,
  8. Janitzia Vazquez-Mellado7,
  9. Maxim Eliseev8,
  10. Geraldine McCarthy9,10,
  11. Lisa K Stamp11,
  12. Fernando Perez-Ruiz12,
  13. Francisca Sivera13,
  14. Hang-Korng Ea14,15,16,
  15. Martijn Gerritsen17,
  16. Carlo Scire18,
  17. Lorenzo Cavagna19,
  18. Chingtsai Lin20,
  19. Yin-Yi Chou21,
  20. Anne-Kathrin Tausche22,
  21. Geraldo da Rocha Castelar-Pinheiro23,
  22. Matthijs Janssen24,
  23. Jiunn-Horng Chen25,26,
  24. Ole Slot27,
  25. Marco Cimmino28,
  26. Till Uhlig29,
  27. Tim L Jansen2
  1. 1Department of Medicine, University of Otago, Wellington, New Zealand
  2. 2Department of Rheumatology, Radboud University Medical Centre, Nijmegen, Netherlands
  3. 3Department of Medicine, University of Auckland, Auckland, New Zealand
  4. 4Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
  5. 5VA Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  6. 6Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  7. 7Servicio de Reumatología, Hospital General de México, México City, México
  8. 8Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia
  9. 9School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
  10. 10Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
  11. 11Department of Medicine, University of Otago, Christchurch, Canterbury, New Zealand
  12. 12Rheumatology Division, Hospital Universitario Cruces & BioCruces Health Research Institute, Vizcaya, Spain
  13. 13Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain
  14. 14University of Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
  15. 15INSERM, UMR 1132, Hôpital Lariboisière, Paris, France
  16. 16Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Lariboisière, Service de Rhumatologie, Centre Viggo Petersen, Pôle Appareil Locomoteur, 2, Rue Ambroise Paré, Paris, France
  17. 17Department of Rheumatology, Amsterdam Rheumatology Immunology Center (ARC), Westfries Gasthuis, Hoorn, the Netherlands
  18. 18Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
  19. 19Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
  20. 20Division of Rheumatology and Immunology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan, ROC
  21. 21Taichung Veterans’ General Hospital, Taichung, Taiwan, ROC
  22. 22Division of Rheumatology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany
  23. 23Division of Rheumatology, Department of Internal Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
  24. 24Department of Rheumatology, Rijnstate Hospital, Arnhem, the Netherlands
  25. 25School of Medicine, China Medical University, Taichung, Taiwan, ROC
  26. 26Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, ROC
  27. 27Centre of Rheumatology and Spine Disorders, Copenhagen University Hospital Glostrup, Glostrup, Denmark
  28. 28Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
  29. 29National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Vinderen, Oslo, Norway
  1. Correspondence to Dr William Taylor, Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington 6039, New Zealand; will.taylor{at}


Objectives To compare the sensitivity and specificity of different classification criteria for gout in early and established disease.

Methods This was a cross-sectional study of consecutive rheumatology clinic patients with joint swelling in which gout was defined by presence or absence of monosodium urate crystals as observed by a certified examiner at presentation. Early disease was defined as patient-reported onset of symptoms of 2 years or less.

Results Data from 983 patients were collected and gout was present in 509 (52%). Early disease was present in 144 gout cases and 228 non-cases. Sensitivity across criteria was better in established disease (95.3% vs 84.1%, p<0.001) and specificity was better in early disease (79.9% vs 52.5%, p<0.001). The overall best performing clinical criteria were the Rome criteria with sensitivity/specificity in early and established disease of 60.3%/84.4% and 86.4%/63.6%. Criteria not requiring synovial fluid analysis had sensitivity and specificity of less than 80% in early and established disease.

Conclusions Existing classification criteria for gout have sensitivity of over 80% in early and established disease but currently available criteria that do not require synovial fluid analysis have inadequate specificity especially later in the disease. Classification criteria for gout with better specificity are required, although the findings should be cautiously applied to non-rheumatology clinic populations.

  • Gout
  • Epidemiology
  • Synovial fluid

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