ACR-EULAR Gout Classification Criteria Clinical Calculator and Pathways

The Acute Gout Diagnosis Rule can help rule in or rule out gout, reducing the need for synovial fluid in highly likely patients and encouraging a broad differential in gout-unlikely patients using mostly clinical criteria.

Step One - Entry Criterion

≥1 episode of swelling, pain, or tenderness in a peripheral joint/bursa

No Yes

Step Two - Sufficient Criterion

Presence of MSU crystals in a symptomatic joint, bursa, or tophus

No Yes

Step Three - Classification Criteria

Pattern of joint/bursa involvement during episodes

Joint/bursa other than ankle, midfoot or 1st MTP (or involvement in a polyarthritis)

Ankle OR midfoot (as part of monoarticular/oligoarticular episode without 1st MTP)

1st MTP (as part of monoarticular or oligoarticular episode)

How many characteristics during episode(s)

Erythema overlying joint (reported or observed)
Can't bear touch or pressure to joint
Great difficulty with walking or inability to use joint

No characteristics

One characteristics

Two characteristics

Three characteristics

How many episodes with the following time-course

≥2 time course symptoms, regardless of anti-inflammatory use:

Time to maximal pain < 24 hours
Resolution of symptoms in ≤14 days
Complete resolution (to baseline level) between symptomatic episodes

No typical episodes

One typical episodes

Recurrent typical episodes

Evidence of tophus

Draining or chalk-like subcutaneous nodule, located in typical locations: joints, ears, olecranon bursae, finger pads, tendons (e.g., Achilles)

Absent

Present

Serum Urate

(Measured by uricase method.) Ideally scored when patient not taking urate-lowering treatment and patient was >4 weeks from an episode. If practical, retest under those conditions. Highest value irrespective of timing should be used.

< 4mg/dL [< 0.24mM]

-4

≥ 4 or < 6mg/dL [≥ 0.24 or < 0.36mM]

≥ 6 or < 8mg/dL [≥ 0.36 or < 0.48mM]

≥ 8 or < 10mg/dL [≥ 0.48 or < 0.60mM]

≥ 10mg/dL [≥ 0.60mM]

Synovial fluid analysis of a symptomatic (ever) joint or bursa

Should be assessed by a trained observer.

Not done

Negative for MSU

Imaging evidence of urate deposition in symptomatic joint/bursa

Ultrasound: double-contour sign OR DECT: Demonstrates urate deposition.

Absent or not done

Present

Imaging evidence of gout-related joint damage

X-Ray of hands or feet with ≥1 erosion

Absent

Present

Source: Neogi T, et al. 2015 Gout Classification Criteria: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative. Arthritis & Rheumatology. 20015; 67: 2557–2568. doi: 10.1002/art.39254

ACR-EULAR Gout Classification Criteria

The Acute Gout Diagnosis Rule can help rule in or rule out gout, reducing the need for synovial fluid in highly likely patients and encouraging a broad differential in gout-unlikely patients using mostly clinical criteria.

Step One - Entry Criterion

Step Two - Sufficient Criterion

Step Three - Classification Criteria

Interpretation