_id

683a1603c782e11e38d1b12d

id

2195

title

ACR/EULAR Gout Classification Criteria

full_title

ACR/EULAR Gout Classification Criteria

short_title

ACR/EULAR Gout Criteria

med_description

Provides formal diagnostic criteria for gout.

short_description

Gout diagnostic criteria.

slug

acr-eular-gout-classification-criteria

description

The ACR/EULAR Gout Classification Criteria aids in classification of likelihood of gout.

keywords

acr eular, gout classification, acreular, acr gout, eular gout classification, acr gout classification, gout score, gout algorithm, chronic gout classification, chronic gout prognosis, chronic gout diagnosis

complaint

[ "Joint Pain" ]

formula

Addition of selected points.

evidence

• These criteria were developed as a consensus by leading gout experts; interestingly, the criteria were reviewed and agreed upon, then weighted and confirmed in a small set of gout patients.
  • These were then included in a validation larger cohort (the Study for Updated Gout Classification Criteria [SUGAR]).
• The AUC for the ROC for these criteria was 0.95, with a sensitivity of 0.92 and specificity of .89. The clinical-only criteria (without other tests) AUC was 0.89.

measurements

[]

information

refrences

{ "Clinical Practice Guidelines": [ { "href": "", "text": "" } ], "Manufacturer Website": [ { "href": "", "text": "" } ], "Original/Primary Reference": [ { "href": "https://onlinelibrary.wiley.com/doi/10.1002/art.39254/full", "text": "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" } ], "Other References": [ { "href": "", "text": "" } ], "Outcomes": [ { "href": "", "text": "" } ], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/25776731", "text": "Aggarwal R. Distinctions Between Diagnostic and Classification Criteria?. Arthritis Care Res. 2015; 67: 891–897. doi: 10.1002/acr.22583." } ], "Validations": [] }

pearls

• The ACR/EULAR Classification can be used to formally diagnose gout.
• The criteria allow for a non-synovium diagnosis of gout (since presence of monosodium urate crystals in a symptomatic joint is the gold standard for gout) to assist clinicians when synovial testing is not possible (small joint, lab testing not available).

usecase

• Patients with mono or oligo-arthritis of unclear etiology where gout is in the differential diagnosis.

reasons

These criteria can substitute for synovial fluid analysis (the gold standard) if fluid analysis is not possible, or if there are sufficient other criteria that the patient meets.

next_advice

• Gout flares are often treated with some combination of steroids, NSAIDS (classically, indomethacin), opioids for extreme pain, and colchicine, depending on a patient's age and other risk factors for complications.
• After the initial flare, patients may benefit from urate-lowering therapies like allopurinol.

next_actions

next_management

Other causes of monoarthritis should be considered if patient does not meet criteria for gout, for example: pseudogout, septic arthritis, reactive arthritis, psoriatic, rheumatoid, or osteoarthritis.

diseases

[ "Gout" ]

input_schema

[ { "inct": null, "option_fhir_rules": null, "subheading": "Step One - Entry Criterion", "subheading_instructions": "If yes, 7+ Classification Criteria required for positive diagnosis", "type": "subheading" }, { "conditionality": "", "default": 1, "label_en": "≥1 episode of swelling, pain, or tenderness in a peripheral joint/bursa", "md_calc_info_concept": null, "name": "entry", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "inct": null, "option_fhir_rules": null, "subheading": "Step Two - Sufficient Criterion", "subheading_instructions": "If yes, diagnosis is positive", "type": "subheading" }, { "conditionality": "", "default": 0, "label_en": "Presence of Monosodium Urate (MSU) crystals in a symptomatic joint, bursa, or tophus", "md_calc_info_concept": null, "name": "sufficient", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "", "type": "toggle" }, { "inct": null, "option_fhir_rules": null, "subheading": "Step Three - Classification Criteria", "subheading_instructions": "7+ required for positive diagnosis", "type": "subheading" }, { "conditionality": "entry == 1 && sufficient == 0", "default": 0, "label_en": "Pattern of joint/bursa involvement during episodes", "mdcalc_info_concept": null, "name": "bursa", "option_fhir_rules": null, "optional": false, "options": [ { "label": "Joint/bursa other than ankle, midfoot or 1st MTP (or involvement in a polyarthritis)", "value": 0 }, { "label": "Ankle OR midfoot (as part of monoarticular/oligoarticular episode without 1st MTP)", "value": 1 }, { "label": "1st MTP (as part of monoarticular or oligoarticular episode)", "value": 2 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": "entry == 1 && sufficient == 0", "default": 0, "label_en": "How many characteristics during episode(s)?", "mdcalc_info_concept": null, "name": "charac", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No Characteristics", "value": 0 }, { "label": "One Characteristics", "value": 1 }, { "label": "Two Characteristics", "value": 2 }, { "label": "Three Characteristics", "value": 3 } ], "show_points": true, "tips_en": "Erythema overlying joint (reported or observed); can't bear touch or pressure to joint; great difficulty with walking or inability to use joint.", "type": "radio" }, { "conditionality": "entry == 1 && sufficient == 0", "default": 0, "label_en": "How many episodes with the following time-course?", "mdcalc_info_concept": null, "name": "time", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No typical episodes", "value": 0 }, { "label": "One typical episode", "value": 1 }, { "label": "Recurrent typical episodes", "value": 2 } ], "show_points": true, "tips_en": "≥2 time course symptoms, regardless of anti-inflammatory use: (1)Time to maximal pain < 24 hours; (2)Resolution of symptoms in ≤14 days; (3)Complete resolution (to baseline level) between symptomatic episodes.", "type": "radio" }, { "conditionality": "entry == 1 && sufficient == 0", "default": 0, "label_en": "Evidence of tophus", "mdcalc_info_concept": null, "name": "tophus", "option_fhir_rules": null, "optional": false, "options": [ { "label": "Absent", "value": 0 }, { "label": "Present", "value": 4 } ], "show_points": true, "tips_en": "Draining or chalk-like subcutaneous nodule, located in typical locations: joints, ears, olecranon bursae, finger pads, tendons (e.g., Achilles).", "type": "radio" }, { "conditionality": "entry == 1 && sufficient == 0", "default": 1, "label_en": "<p>Serum Urate</p>", "mdcalc_info_concept": null, "name": "urate", "option_fhir_rules": null, "optional": false, "options": [ { "label": "< 4mg/dL [< 0.24mM]", "value": -4 }, { "label": "≥ 4 or < 6mg/dL [≥ 0.24 or < 0.36mM]", "value": 0 }, { "label": "≥ 6 or < 8mg/dL [≥ 0.36 or < 0.48mM]", "value": 2 }, { "label": "≥ 8 or < 10mg/dL [≥ 0.48 or < 0.60mM]", "value": 3 }, { "label": "≥ 10mg/dL [≥ 0.60mM]", "value": 4 } ], "show_points": true, "tips_en": "(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.", "type": "radio" }, { "conditionality": "entry == 1 && sufficient == 0", "default": 1, "label_en": "<p>Synovial fluid analysis of a symptomatic (ever) joint or bursa</p>", "mdcalc_info_concept": null, "name": "synovial", "option_fhir_rules": null, "optional": false, "options": [ { "label": "Negative for MSU", "value": -2 }, { "label": "Not done", "value": 0 } ], "show_points": true, "tips_en": "Should be assessed by a trained observer.", "type": "radio" }, { "conditionality": "entry == 1 && sufficient == 0", "default": 0, "label_en": "<p>Imaging evidence of urate deposition in symptomatic joint/bursa</p>", "mdcalc_info_concept": null, "name": "decomp", "option_fhir_rules": null, "optional": false, "options": [ { "label": "Absent or not done", "value": 0 }, { "label": "Present", "value": 4 } ], "show_points": true, "tips_en": "Ultrasound: double-contour sign OR DECT: Demonstrates urate deposition.", "type": "radio" }, { "conditionality": "entry == 1 && sufficient == 0", "default": 0, "label_en": "<p>Imaging evidence of gout-related joint damage</p>", "mdcalc_info_concept": null, "name": "imaging", "option_fhir_rules": null, "optional": false, "options": [ { "label": "Absent", "value": 0 }, { "label": "Present", "value": 4 } ], "show_points": true, "tips_en": "X-Ray of hands or feet with ≥1 erosion.", "type": "radio" } ]

instructions

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.

published

2022-04-21T20:29:08.624Z

purpose

[ "Diagnosis" ]

search_terms

[ "acr", "eular", "gout", "dx", "diagnosis", "classification", "urate", "tophus", "bursa", "ACR-EULAR", "ACR/EULAR", "ACREULAR" ]

seo

{ "keywords_en": "acr eular, gout classification, acreular, acr gout, eular gout classification, acr gout classification, gout score, gout algorithm, chronic gout classification, chronic gout prognosis, chronic gout diagnosis", "meta_description_en": "The ACR/EULAR Gout Classification Criteria aids in classification of likelihood of gout." }

specialty

[ "Emergency Medicine", "Family Practice", "Internal Medicine", "Orthopedics", "Primary Care", "Rheumatology" ]

departments

[ "Rheumatologic" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": "2175", "short_title_en": "Acute Gout Diagnosis Rule", "slug": "acute-gout-diagnosis-rule" } ]

ismed

false

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "rheumatology" ]

cleaned_use

[ "Patients with mono or oligo-arthritis of unclear etiology where gout is in the differential diagnosis." ]

pub

false