Unifying Concepts

Criteria for the Classification of Acute Gouty Arthritis

Acute gouty arthritis is a sudden attack of pain in the joints, especially in the feet and legs, that occur when uric acid builds up in the joints.

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:

  1. More than one attack of acute arthritis.

  2. Development of maximal inflammation within 1 day.

  3. Attack of monarticular arthritis.

  4. Observation of joint redness.

  5. Pain or swelling in first metatarsophalangeal joint.

  6. Unilateral attack involving first metatarsophalangeal joint.

  7. Unilateral attack involving tarsal joint.

  8. Suspected tophus.

  9. Hyperuricemia.

  10. Asymmetric swelling within a joint on x-ray.

  11. Subcortical cysts without erosions on x-ray.

  12. 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

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



  1. 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]
  2. 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

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