Criteria for the Classification of Acute Gouty Arthritis
A. Presence of characteristic urate crystals in the joint fluid, or
B. Presence of a tophus proven to contain urate crystals by chemical means or polarized light microscopy, or
C. Presence of six of the following clinical, laboratory, and radiographic phenomena:
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More than one attack of acute arthritis.
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Development of maximal inflammation within 1 day.
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Attack of monarticular arthritis.
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Observation of joint redness.
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Pain or swelling in first metatarsophalangeal joint.
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Unilateral attack involving first metatarsophalangeal joint.
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Unilateral attack involving tarsal joint.
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Suspected tophus.
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Hyperuricemia.
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Asymmetric swelling within a joint on x-ray.
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Subcortical cysts without erosions on x-ray.
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Negative culture of joint fluid for microorganisms during attack of joint inflammation.
Comparison of Gout and Pseudogout
Gout | Pseudogout | |
Ratio of men to women | 7:1 | 1:1.5 |
Age group affected |
Men >40 years old Postmenopausal women |
Elderly |
Serum urate | Elevated | Normal |
Joints involved | First metatarsophalangeal (MTP) joint, insteps, knees, wrists, fingers, olecranon bursae | Knees, wrists, ankles |
Involvement of first MTP (podagra) | Common | Rare |
Tophi | Present | Rare tophi-like deposits |
Radiographic findings | Erosions with overhanging edges | Chondrocalcinosis |
Crystals | Needle-shaped, strong negative birefringence | Rhomboid-shaped, weakly positive birefringence |
References:
- Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yu TF. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. 1977 Apr;20(3):895-900. [Medline]
- Schlesinger N. Diagnosis of gout: clinical, laboratory, and radiologic findings. Am J Manag Care. 2005 Nov;11(15 Suppl):S443-50. [Medline]
Created: Mar 27, 2006