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Rationale:
- Joint aspiration sometimes fails to establish the diagnosis, such as when no crystals are seen or no fluid is obtained. In
some cases, patients may decline the procedure or have contraindications. The American College of Rheumatology criteria can
be helpful in these circumstances.
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Evidence:
- Six or more criteria were present in 88% of patients with acute primary gout, <3% of those with septic arthritis or rheumatoid arthritis, and
11% of those with pseudogout (from calcium pyrophosphate dihydrate crystals) (12).
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Comments:
- When monosodium urate crystals cannot be found, use the following alternative criteria: Classic history of monoarticular arthritis
with subsequent interval free of symptoms; rapid resolution of synovitis with colchicine therapy; and hyperuricemia. However,
because colchicine is adminstered infrequently, the latter criteria may not be helpful (12).
- The clinical presentation of acute gout can be dramatic. If a patient presents with the classic symptoms of gout the clinician
should consider gout first among all possible diagnoses.
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Grace P. Teal, MD (deceased) has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Howard A. Fuchs, MD, is a consultant for TAP Pharmaceuticals.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2009 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Gout
> Diagnosis
