PT  - JOURNAL ARTICLE
AU  - Tuhina Neogi
AU  - Tim L Th A Jansen
AU  - Nicola Dalbeth
AU  - Jaap Fransen
AU  - H Ralph Schumacher
AU  - Dianne Berendsen
AU  - Melanie Brown
AU  - Hyon Choi
AU  - N Lawrence Edwards
AU  - Hein J E M Janssens
AU  - Frédéric Lioté
AU  - Raymond P Naden
AU  - George Nuki
AU  - Alexis Ogdie
AU  - Fernando Perez-Ruiz
AU  - Kenneth Saag
AU  - Jasvinder A Singh
AU  - John S Sundy
AU  - Anne-Kathrin Tausche
AU  - Janitzia Vaquez-Mellado
AU  - Steven A Yarows
AU  - William J Taylor
TI  - 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative
AID  - 10.1136/annrheumdis-2015-208237
DP  - 2015 Oct 01
TA  - Annals of the Rheumatic Diseases
PG  - 1789--1798
VI  - 74
IP  - 10
4099  - http://ard.bmj.com/content/74/10/1789.short
4100  - http://ard.bmj.com/content/74/10/1789.full
SO  - Ann Rheum Dis2015 Oct 01; 74
AB  - 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.