{"id":2192,"date":"2018-08-07T15:42:44","date_gmt":"2018-08-07T15:42:44","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/?p=1159"},"modified":"2026-02-12T18:52:07","modified_gmt":"2026-02-12T18:52:07","slug":"gout","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/gout\/","title":{"rendered":"Gout Classification Criteria"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>Gout, which is characterized by deposition of\u00a0monosodium urate monohydrate (MSU) in synovial fluid\u00a0and other tissues, is the most common form of inflammatory\u00a0arthritis.<!--more--><br \/>\n<strong>Gout Classification Criteria<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr style=\"height: 24px;\">\n<td style=\"width: 254px; height: 24px;\"><\/td>\n<td style=\"width: 280px; height: 24px;\"><strong>Categories<\/strong><\/td>\n<td style=\"width: 50px; height: 24px;\"><strong>Score<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 72px;\">\n<td style=\"width: 254px; height: 72px;\"><strong>Step 1:<\/strong> Entry criterion (only apply criteria below to those meeting\u00a0this entry criterion)<\/td>\n<td style=\"width: 280px; height: 72px;\">At least 1 episode of swelling, pain, or tenderness in a\u00a0peripheral joint or bursa<\/td>\n<td style=\"width: 50px; height: 72px;\"><\/td>\n<\/tr>\n<tr style=\"height: 72px;\">\n<td style=\"width: 254px; height: 72px;\"><strong>Step 2:<\/strong> Sufficient criterion (if met, can classify as gout without applying criteria below)<\/td>\n<td style=\"width: 280px; height: 72px;\">Presence of MSU crystals in a symptomatic joint or\u00a0bursa (i.e., in synovial fluid) or tophus<\/td>\n<td style=\"width: 50px; height: 72px;\"><\/td>\n<\/tr>\n<tr style=\"height: 48px;\">\n<td style=\"width: 254px; height: 48px;\"><strong>Step 3:<\/strong> Criteria (to be used if sufficient criterion not met)<\/td>\n<td style=\"width: 280px; height: 48px;\"><\/td>\n<td style=\"width: 50px; height: 48px;\"><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 584px; height: 24px;\" colspan=\"3\">Clinical<\/td>\n<\/tr>\n<tr style=\"height: 96px;\">\n<td style=\"width: 254px; height: 168px;\" rowspan=\"2\">Pattern of joint\/bursa involvement during\u00a0symptomatic episode(s) ever\u2020<\/td>\n<td style=\"width: 280px; height: 96px;\">Ankle or midfoot (as part of monoarticular or oligoarticular\u00a0episode without involvement of the first\u00a0metatarsophalangeal joint<\/td>\n<td style=\"width: 50px; text-align: center; height: 96px;\">1<\/td>\n<\/tr>\n<tr style=\"height: 72px;\">\n<td style=\"width: 280px; height: 72px;\">Involvement of the first metatarsophalangeal joint (as\u00a0part of monoarticular or oligoarticular episode)<\/td>\n<td style=\"width: 50px; text-align: center; height: 72px;\">2<\/td>\n<\/tr>\n<tr style=\"height: 79px;\">\n<td style=\"width: 50px; height: 238px;\" rowspan=\"3\">Characteristics of symptomatic episode(s) ever<\/p>\n<ul>\n<li>Erythema overlying affected joint (patient- reported or physician-observed)<\/li>\n<li>Can\u2019t bear touch or pressure to affected joint<\/li>\n<li>Great difficulty with walking or inability to use affected joint<\/li>\n<\/ul>\n<\/td>\n<td style=\"width: 50px; height: 79px;\">One characteristic<\/td>\n<td style=\"width: 50px; height: 79px; text-align: center;\">1<\/td>\n<\/tr>\n<tr style=\"height: 79px;\">\n<td style=\"width: 50px; height: 79px;\">Two characteristics<\/td>\n<td style=\"width: 50px; height: 79px; text-align: center;\">2<\/td>\n<\/tr>\n<tr style=\"height: 80px;\">\n<td style=\"width: 50px; height: 80px;\">Three characteristics<\/td>\n<td style=\"width: 50px; height: 80px; text-align: center;\">3<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 254px; height: 48px;\" rowspan=\"2\">Time course of episode(s) ever<br \/>\nPresence (ever) of \u22652, irrespective of\u00a0antiinflammatory treatment:<\/p>\n<ul>\n<li>Time to maximal pain, &lt;24 hours<\/li>\n<li>Resolution of symptoms in \u226414 days<\/li>\n<li>Complete resolution (to baseline level) between symptomatic episodes<\/li>\n<\/ul>\n<\/td>\n<td style=\"width: 280px; height: 24px;\">One typical episode<\/td>\n<td style=\"width: 50px; height: 24px; text-align: center;\">1<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 280px; height: 24px;\">Recurrent typical episodes<\/td>\n<td style=\"width: 50px; height: 24px; text-align: center;\">2<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 254px; height: 24px;\">Clinical evidence of tophus<br \/>\nDraining or chalk-like subcutaneous nodule under transparent\u00a0skin, often with overlying vascularity, located in\u00a0typical locations: joints, ears, olecranon bursae, finger pads, tendons (e.g., Achilles)<\/td>\n<td style=\"width: 280px; height: 24px;\">Present<\/td>\n<td style=\"width: 50px; height: 24px; text-align: center;\">4<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 584px; height: 24px;\" colspan=\"3\">Laboratory<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 254px; height: 96px;\" rowspan=\"4\">Serum urate: Measured by uricase method. Ideally should be scored at a time when the patient was\u00a0not receiving urate-lowering treatment and it was &gt;4\u00a0weeks from the start of an episode (i.e., during intercritical\u00a0period); if practicable, retest under those conditions.\u00a0The highest value irrespective of timing should be scored.<\/td>\n<td style=\"width: 280px; height: 24px;\">&lt;4 mg\/dl (&lt;0.24 mmoles\/liter)\u2021<\/td>\n<td style=\"width: 50px; height: 24px; text-align: center;\">-4<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 280px; height: 24px;\">6\u20138 mg\/dl (0.36\u2013&lt;0.48 mmoles\/liter)<\/td>\n<td style=\"width: 50px; height: 24px; text-align: center;\">2<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 280px; height: 24px;\">8\u2013&lt;10 mg\/dl (0.48\u2013&lt;0.60 mmoles\/liter)<\/td>\n<td style=\"width: 50px; height: 24px; text-align: center;\">3<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 280px; height: 24px;\">\u226510 mg\/dl (\u22650.60 mmoles\/liter)<\/td>\n<td style=\"width: 50px; height: 24px; text-align: center;\">4<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 254px; height: 24px;\">Synovial fluid analysis of a symptomatic (ever)\u00a0joint or bursa (should be assessed by a\u00a0trained observer)\u00a7<\/td>\n<td style=\"width: 280px; height: 24px;\">MSU negative<\/td>\n<td style=\"width: 50px; height: 24px; text-align: center;\">-2<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 584px; height: 24px;\" colspan=\"3\">Imaging<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 254px; height: 24px;\">Imaging evidence of urate deposition in\u00a0symptomatic (ever) joint or bursa:\u00a0ultrasound evidence of double-contour sign#\u00a0or DECT demonstrating urate deposition**<\/td>\n<td style=\"width: 280px; height: 24px;\">Present (either modality)<\/td>\n<td style=\"width: 50px; height: 24px; text-align: center;\">4<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 254px; height: 24px;\">Imaging evidence of gout-related joint damage:\u00a0conventional radiography of the hands\u00a0and\/or feet demonstrates at least 1 erosion\u2020\u2020<\/td>\n<td style=\"width: 280px; height: 24px;\">Present<\/td>\n<td style=\"width: 50px; height: 24px; text-align: center;\">4<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>\u2020 Symptomatic episodes are periods of symptoms that include any swelling, pain, and\/or tenderness in a peripheral joint or bursa.<br \/>\n\u2021 If serum urate level is &lt;4 mg\/dl (&lt;0.24 mmoles\/liter), subtract 4 points; if serum urate level is \u22654-&lt;6 mg\/dl (\u22650.24-&lt;0.36 mmoles\/liter),\u00a0score this item as 0.<br \/>\n\u00a7 If polarizing microscopy of synovial fluid from a symptomatic (ever) joint or bursa by a trained examiner fails to show monosodium urate\u00a0monohydrate (MSU) crystals, subtract 2 points. If synovial fluid was not assessed, score this item as 0.<br \/>\n\u00b6 If imaging is not available, score these items as 0.<br \/>\n# Hyperechoic irregular enhancement over the surface of the hyaline cartilage that is independent of the insonation angle of the ultrasound\u00a0beam (note: false-positive double-contour sign [artifact] may appear at the cartilage surface but should disappear with a change in the insonation\u00a0angle of the probe).<br \/>\n** Presence of color-coded urate at articular or periarticular sites. Images should be acquired using a dual-energy computed tomography\u00a0(DECT) scanner, with data acquired at 80 kV and 140 kV and analyzed using gout-specific software with a 2-material decomposition algorithm\u00a0that color-codes urate. A positive scan is defined as the presence of color-coded urate at articular or periarticular sites. Nailbed, submillimeter,\u00a0skin, motion, beam hardening, and vascular artifacts should not be interpreted as DECT evidence of urate deposition.<br \/>\n\u2020\u2020 Erosion is defined as a cortical break with sclerotic margin and overhanging edge, excluding distal interphalangeal joints and gull wing appearance.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJ, Liot\u00e9 F, Naden RP, Nuki G, Ogdie A, Perez-Ruiz F, Saag K, Singh JA, Sundy JS, Tausche AK, Vazquez-Mellado J, Yarows SA, Taylor WJ.\u00a02015 Gout Classification Criteria: an American College of Rheumatology\/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol. 2015 Oct;67(10):2557-68. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26352873\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJ, Liot\u00e9 F, Naden RP, Nuki G, Ogdie A, Perez-Ruiz F, Saag K, Singh JA, Sundy JS, Tausche AK, Vaquez-Mellado J, Yarows SA, Taylor WJ. 2015 Gout classification criteria: an American College of Rheumatology\/European League Against Rheumatism collaborative initiative.\u00a0Ann Rheum Dis. 2015 Oct;74(10):1789-98. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26359487\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Sun M, Lyu Z, Wang C, Li Y, Zhao D, Ran X, Chen H, Su B, Chang X, Liu P, Yan D, Jiang X, Chen K, Shao J, Teng X, Yao Y, Li Y, Chen Y, Cheng J, Cheng Z, Liu Z, Liu F, Li X, Yin H, Liu C, Lin HY, Chen Y, Tsai WC, Yip RML, Li C, Zhao J. 2024 Update of Chinese Guidelines for Diagnosis and Treatment of Hyperuricemia and Gout Part I: Recommendations for General Patients. Int J Rheum Dis. 2025 Jul;28(7):e70375. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40692263\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Jul 23, 2018.<br \/>\nUp-date Feb 12, 2026.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[45],"tags":[419,195,166,167,16,15,418,417,416,415,414,196],"class_list":["post-2192","post","type-post","status-publish","format-standard","hentry","category-rheumatology","tag-acid","tag-acido","tag-clasificacion","tag-classification","tag-criteria","tag-criterios","tag-gota","tag-gout","tag-urate","tag-urato","tag-uric","tag-urico"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2192","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2192"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2192\/revisions"}],"predecessor-version":[{"id":10662,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2192\/revisions\/10662"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2192"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2192"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2192"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}