_id

683a1603c782e11e38d1b128

id

2175

title

Acute Gout Diagnosis Rule

full_title

Acute Gout Diagnosis Rule

short_title

Acute Gout Diagnosis Rule

med_description

Risk stratifies for gout vs non-gout arthritis and helps determine which patients benefit most from joint aspiration.

short_description

Risk for gout.

slug

acute-gout-diagnosis-rule

description

The Acute Gout Diagnosis Rule determines which patients are at high risk for gout and should undergo further testing with joint fluid aspiration.

keywords

gout diagnosis, acute gout diagnosis, gout dx, fluid aspiration gout, high risk gout, acute gout diagnosis, gout diagnosis rule

complaint

[ "Joint Pain" ]

formula

Addition of selected points, see below.

evidence

• As mentioned above, this rule was developed and validated twice in Europe, and may be less applicable to non-European populations.
• The AUC for the receiver operator curves from the original and validation studies ranged from 0.86-0.89, suggesting overall good diagnostic accuracy.
• The rule improves on clinician gestalt: “PPV of the clinical diagnosis may improve from 0.64 to 0.87 and the NPV from 0.87 to 0.95.”
• The authors note that even the “gold standard” of monosodium urate crystals in fluid analysis is falsely negative about 5% of the time, suggesting that some of the “false positive” patients in the study with an “unknown arthritis” may have actually had gout as well.

measurements

[]

information

Score interpretation:

refrences

{ "Clinical Practice Guidelines": [ { "href": "", "text": "" } ], "Manufacturer Website": [ { "href": "", "text": "" } ], "Original/Primary Reference": [ { "href": "https://archinte.jamanetwork.com/article.aspx?articleid=225738", "text": "Janssens HM, Fransen J, van de Lisdonk EH, van Riel PM, van Weel C, Janssen M. A Diagnostic Rule for Acute Gouty Arthritis in Primary Care Without Joint Fluid Analysis.Arch Intern Med. 2010;170(13):1120-1126. doi:10.1001/archinternmed.2010.196." } ], "Other References": [ { "href": "", "text": "" } ], "Outcomes": [ { "href": "", "text": "" } ], "Validation": [ { "href": "https://www.researchgate.net/publication/265717594_The_validation_of_a_diagnostic_rule_for_gout_without_joint_fluid_analysis_a_prospective_study", "text": "Keinhorst LBE, et. al. The validation of a diagnostic rule for gout without joint fluid analysis: a prospective study. Rheumatology (Oxford). 2015 Apr;54(4):609-14. doi: 10.1093/rheumatology/keu378. Epub 2014 Sep 16." } ], "Validations": [] }

pearls

• The Acute Gout Diagnosis Rule helps reduce unnecessary joint aspirations by predicting gout risk based on clinical criteria.
• It was originally studied and validated in two primary care cohorts in Europe, so may not be as applicable in non-European populations.
• Score correlates with likelihood of gout, with scores ≤4 unlikely to be gout, scores ≥8 likely to be gout, and 4-8 indeterminate.
• False positives in the studies were mostly “unknown arthritis” and management typically did not change. Septic arthritis was not seen in these high scores.
• Low scores are unlikely to be gout and other causes of gout should be considered, including pseudogout, septic arthritis, reactive arthritis, psoriatic, rheumatoid, or osteoarthritis.

usecase

A patient with a new monoarthritis.

reasons

The Acute Gout Diagnosis Rule can help rule in or rule out the diagnosis of gout, and help determine which patients benefit from joint aspiration and which could be treated empirically for gout specifically. The rule also out-performs clinician gestalt and improves diagnostic accuracy.

next_advice

The authors provide several recommendations based on a patient's score:

• ≤4 points: Unlikely gout. Other causes of monoarthritis should be considered, for example: pseudogout, septic arthritis, reactive arthritis, psoriatic, rheumatoid, or osteoarthritis.
• 4-8 points: These patients are most likely to benefit from joint aspiration and fluid analysis for urate crystals.
• ≥8 points: Gouty arthritis is very likely, and empiric gout medications can be started as opposed to more generic arthritis treatments (like NSAIDs).

next_actions

next_management

• 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.

diseases

[ "Gout" ]

input_schema

[ { "conditionality": null, "default": 0, "label_en": "Male sex", "md_calc_info_concept": null, "name": "male", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": 0, "label_en": "Previous patient-reported arthritis attack", "md_calc_info_concept": null, "name": "attack", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": 0, "label_en": "Onset within 1 day", "md_calc_info_concept": null, "name": "onset", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 0.5 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": 0, "label_en": "Joint redness", "md_calc_info_concept": null, "name": "red", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": 0, "label_en": "1st metatarsophalangeal joint involvement", "md_calc_info_concept": null, "name": "mtp", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2.5 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": null, "default": 0, "label_en": "Hypertension or ≥1 cardiac diseases", "md_calc_info_concept": null, "name": "cvd", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1.5 } ], "show_points": true, "tips_en": "Angina, MI, CHF, Stroke/TIA, PVD", "type": "toggle" }, { "conditionality": null, "default": 0, "label_en": "Serum uric acid > 5.88 mg/dL (0.35 mmol/L)", "md_calc_info_concept": null, "name": "uric", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 3.5 } ], "show_points": true, "tips_en": "", "type": "toggle" } ]

instructions

published

2022-04-21T20:29:08.105Z

purpose

[ "Diagnosis" ]

search_terms

[ "gout", "arthritis", "septic joint", "fluid", "aspiration", "mtp", "janssen", "jansen" ]

seo

{ "keywords_en": "gout diagnosis, acute gout diagnosis, gout dx, fluid aspiration gout, high risk gout, acute gout diagnosis, gout diagnosis rule", "meta_description_en": "The Acute Gout Diagnosis Rule determines which patients are at high risk for gout and should undergo further testing with joint fluid aspiration." }

specialty

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

departments

[ "Musculoskeletal", "Rheumatologic" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 2195, "short_title_en": "ACR/EULAR Gout Criteria", "slug": "acr-eular-gout-classification-criteria" }, { "calcId": 10514, "short_title_en": "2012 Criteria for PMR", "slug": "2012-eular-acr-classification-criteria-polymyalgia-rheumatica" }, { "calcId": 10039, "short_title_en": "CASPAR Criteria for PsA", "slug": "caspar-criteria-psoriatic-arthritis" } ]

ismed

false

section

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

cleaned_departments

[ "orthopedics", "rheumatology" ]

cleaned_use

[ "A patient with a new monoarthritis." ]

pub

false