In order to classify gout without identification of monosodium urate (MSU) crystals, the American College of Rheumatism (ACR) formulated criteria in 1977.1 Of 11 criteria, 6 or more 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 But, as they are widely used, and cited, testing their validity is critical to our ability to understand and treat gout.4
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