A weighted classification tool for symptomatic gout using entry, sufficient, clinical, laboratory, and imaging criteria.
INSTRUCTIONS
Serum urate should ideally be interpreted outside of an acute flare and, if possible, off urate-lowering therapy, as levels may be transiently low during acute attacks.
≥1 episode of swelling, pain, or tenderness in a peripheral joint/bursa*
Presence of monosodium urate (MSU) crystals in a symptomatic joint, bursa, or tophus*
Pattern of joint/bursa involvement during episodes*
Joint/bursa other than ankle, midfoot or 1st MTP (or involvement in a polyarthritis)0
Ankle OR midfoot (as part of monoarticular/oligoarticular episode without 1st MTP)+1
1st MTP (as part of monoarticular or oligoarticular episode)+2
How many characteristics during episode(s)?*
None0
One+1
Two+2
Three+3
How many episodes with the following time-course?*
No typical episodes0
One typical episode+1
Recurrent typical episodes+2
Evidence of tophus*
Serum urate*
<4 mg/dL [<0.24 mM]-4
≥4 or <6 mg/dL [≥0.24 or <0.36 mM]0
≥6 or <8 mg/dL [≥0.36 or <0.48 mM]+2
≥8 or <10 mg/dL [≥0.48 or <0.60 mM]+3
≥10 mg/dL [≥0.60 mM]+4
Synovial fluid analysis of a symptomatic (ever) joint or bursa*
Negative for MSU-2
Not done0
Imaging evidence of urate deposition in symptomatic joint/bursa*
