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2015 Gout Classification Criteria: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative
Author(s) -
Neogi Tuhina,
Jansen Tim L. Th. A.,
Dalbeth Nicola,
Fransen Jaap,
Schumacher H. Ralph,
Berendsen Dianne,
Brown Melanie,
Choi Hyon,
Edwards N. Lawrence,
Janssens Hein J. E. M.,
Lioté Frédéric,
Naden Raymond P.,
Nuki George,
Ogdie Alexis,
PerezRuiz Fernando,
Saag Kenneth,
Singh Jasvinder A.,
Sundy John S.,
Tausche AnneKathrin,
VaquezMellado Janitzia,
Yarows Steven A.,
Taylor William J.
Publication year - 2015
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.39254
Subject(s) - tophus , gout , medicine , rheumatism , rheumatology , gold standard (test) , radiology , synovial fluid , physical therapy , hyperuricemia , pathology , osteoarthritis , uric acid , alternative medicine
Objective Existing criteria for the classification of gout have suboptimal sensitivity and/or specificity, and were developed at a time when advanced imaging was not available. The current effort was undertaken to develop new classification criteria for gout. Methods An international group of investigators, supported by the American College of Rheumatology and the European League Against Rheumatism, conducted a systematic review of the literature on advanced imaging of gout, a diagnostic study in which the presence of monosodium urate monohydrate (MSU) crystals in synovial fluid or tophus was the gold standard, a ranking exercise of paper patient cases, and a multicriterion decision analysis exercise. These data formed the basis for developing the classification criteria, which were tested in an independent data set. Results The entry criterion for the new classification criteria requires the occurrence of at least 1 episode of peripheral joint or bursal swelling, pain, or tenderness. The presence of MSU crystals in a symptomatic joint/bursa (i.e., synovial fluid) or in a tophus is a sufficient criterion for classification of the subject as having gout, and does not require further scoring. The domains of the new classification criteria include clinical (pattern of joint/bursa involvement, characteristics and time course of symptomatic episodes), laboratory (serum urate, MSU‐negative synovial fluid aspirate), and imaging (double‐contour sign on ultrasound or urate on dual‐energy computed tomography, radiographic gout‐related erosion). The sensitivity and specificity of the criteria are high (92% and 89%, respectively). Conclusion The new classification criteria, developed using a data‐driven and decision analytic approach, have excellent performance characteristics and incorporate current state‐of‐the‐art evidence regarding gout.