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The limited validity of the criteria of the American College of Rheumatology for classifying gout patients in primary care
  1. Hein J E M Janssens1,*,
  2. Matthijs Janssen2,
  3. Eloy H van de Lisdonk1,
  4. Jaap Fransen3,
  5. Piet L C M van Riel3,
  6. Chris van Weel1
  1. 1 Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, Netherlands;
  2. 2 Department of Rheumatology, Rijnstate Hospital, Arnhem, Netherlands;
  3. 3 Department of Rheumatology, Radboud University Nijmegen Medical Centre, Netherlands
  1. Correspondence to: Hein Janssens, Primary and Community Care, Radboud University Nijmegen, Postbus 9101, Nijmegen, 6500 HB, Netherlands; h.janssens{at}


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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