The Gout Diagnosis

American College of Rheumatology (ACR) 1977 criteria for the diagnosis of acute gout:

The following is highly suggestive of gout:

• The presence of urate crystals in joint fluid
• A tophus containing urate crystals
• Fulfillment of 6 or more of the criteria in Table 1.

(Table 1)  American College of Rheumatology criteria for the classification of acute arthritis of primary gout

1     More than 1 attack of acute arthritis 

2     Maximum inflammation develops within 1 day 

3     Monoarthritis attack 

4     Redness over joints 

5     First metatarsophalangeal joint painful or swollen 

6     Unilateral first metatarsophalangeal joint attack 

7     Unilateral tarsal joint attack 

8     Tophus (proven or suspected) 

9     Hyperuricemia

10     Asymmetric swelling within a joint on radiography

11     Subcortical cysts without erosions on radiography

12     Monosodium urate monohydrate microcrystals in joint fluid during attack

13     Joint fluid culture negative for organisms during attack

Reprinted from Arthritis and Rheumatism (Wallace SL, et al. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 1977; 20:895–900), copyright 1977, with permission of Wiley-Liss, Inc., a subsidiary of John Wiley & Sons, Inc.

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