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:
-
More than one attack of acute arthritis.
-
Development of maximal inflammation within 1 day.
-
Attack of monarticular arthritis.
-
Observation of joint redness.
-
Pain or swelling in first metatarsophalangeal joint.
-
Unilateral attack involving first metatarsophalangeal joint.
-
Unilateral attack involving tarsal joint.
-
Suspected tophus.
-
Hyperuricemia.
-
Asymmetric swelling within a joint on x-ray.
-
Subcortical cysts without erosions on x-ray.
-
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: March 27, 2006