Performance of classification criteria for gout in early and established disease

Annals of the Rheumatic Diseases, BMJ, ISSN 0003-4967

Volume 75, 1, 2016

DOI:10.1136/annrheumdis-2014-206364, Dimensions: pub.1022889862, PMID: 25351521,



  1. (1) University of Otago, grid.29980.3a
  2. (2) Radboud University Nijmegen Medical Centre, grid.10417.33
  3. (3) University of Auckland, grid.9654.e
  4. (4) Boston University School of Medicine, grid.475010.7
  5. (5) University of Pennsylvania, grid.25879.31
  6. (6) Chiang Mai University, grid.7132.7
  7. (7) Hospital General de México, grid.414716.1
  8. (8) Nasonova Research Institute of Rheumatology of Russia, Moscow, Russia.
  9. (9) University College Dublin, grid.7886.1
  10. (10) Rheumatology Division, Hospital Universitario Cruces & BioCruces Health Research Institute, Vizcaya, Spain.
  11. (11) Department Reumatologia, Hospital General Universitario de Elda, Alicante, Spain.
  12. (12) Paris Diderot University, grid.7452.4
  13. (13) VU University Medical Center, grid.16872.3a
  14. (14) Società Italiana di Reumatologia, grid.489604.7
  15. (15) Policlinico San Matteo Fondazione, grid.419425.f
  16. (16) Buddhist Tzu Chi General Hospital, grid.414692.c
  17. (17) Taichung Veterans General Hospital, grid.410764.0
  18. (18) University Hospital Carl Gustav Carus, grid.412282.f
  19. (19) Rio de Janeiro State University, grid.412211.5
  20. (20) Rijnstate Hospital, grid.415930.a
  21. (21) China Medical University, grid.254145.3
  22. (22) Rigshospitalet, grid.475435.4, Capital Region
  23. (23) University of Genoa, grid.5606.5
  24. (24) Diakonhjemmet Hospital, grid.413684.c


OBJECTIVES: To compare the sensitivity and specificity of different classification criteria for gout in early and established disease. METHODS: This was a cross-sectional study of consecutive rheumatology clinic patients with joint swelling in which gout was defined by presence or absence of monosodium urate crystals as observed by a certified examiner at presentation. Early disease was defined as patient-reported onset of symptoms of 2 years or less. RESULTS: Data from 983 patients were collected and gout was present in 509 (52%). Early disease was present in 144 gout cases and 228 non-cases. Sensitivity across criteria was better in established disease (95.3% vs 84.1%, p<0.001) and specificity was better in early disease (79.9% vs 52.5%, p<0.001). The overall best performing clinical criteria were the Rome criteria with sensitivity/specificity in early and established disease of 60.3%/84.4% and 86.4%/63.6%. Criteria not requiring synovial fluid analysis had sensitivity and specificity of less than 80% in early and established disease. CONCLUSIONS: Existing classification criteria for gout have sensitivity of over 80% in early and established disease but currently available criteria that do not require synovial fluid analysis have inadequate specificity especially later in the disease. Classification criteria for gout with better specificity are required, although the findings should be cautiously applied to non-rheumatology clinic populations.

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