This is the entry requirement. A high blood urate result without an eligible episode is not enough to use these criteria.
Urate crystals and joint attacks
Gout assessment.
Gout causes inflammation when monosodium urate crystals accumulate. A high uric-acid result alone does not establish gout, and other causes of a painful swollen joint must be considered.
2015 ACR/EULAR classification criteria. Complete this with your clinician using confirmed findings. These are classification criteria, not a self-diagnosis tool.
When to seek care: A new intensely painful, hot swollen joint needs prompt medical assessment, especially with fever or feeling unwell. Crystals do not exclude a simultaneous joint infection.
These criteria use examination findings and specific test definitions. Do not infer them from symptoms alone; use not sure when a finding has not been assessed.
A trained examiner must identify MSU crystals in fluid from a symptomatic joint/bursa, or in a tophus. If yes, the sufficient criterion applies and no numerical score is needed. If no test was done, choose No confirmed MSU result.
Choose the highest qualifying pattern ever seen. The ankle/midfoot and big-toe patterns must be part of an episode affecting one or a few joints.
Count these three features: redness over the joint; inability to tolerate touch or pressure; major difficulty walking or using the joint.
A typical episode has at least two: maximum pain within <24 hours; resolution within ≤14 days; return to the usual baseline between attacks. This applies irrespective of anti-inflammatory treatment.
A clinician must identify a typical chalky or draining subcutaneous deposit at a characteristic site, such as a finger, ear, joint or tendon.
Use the highest measured value in mg/dL. Ideally measured off urate-lowering treatment and >4 weeks after an attack began. Do not stop medicines yourself; discuss timing and units with your clinician.
A trained examiner finding no MSU crystals subtracts 2 points. The published criteria assign 0 if fluid was not tested; this is not a negative test result.
A qualifying ultrasound double-contour sign or dual-energy CT urate deposition at a symptomatic joint/bursa. Artifacts must be excluded by the reporting clinician.
At least one typical hand/foot erosion with a sclerotic margin and overhanging edge. Exclude distal finger-end joint changes and osteoarthritis gull-wing changes.
Symptoms to discuss
- Sudden painful swelling and redness, often at the big-toe base, ankle or knee.
- Repeated attacks or visible deposits may occur; infection can look similar.
Tests and care
- Joint-fluid examination for crystals when appropriate, serum urate and kidney-function testing.
- Ultrasound, dual-energy CT or X-ray in selected cases. A low urate during an attack does not by itself rule out gout.
Treatment of an attack and long-term urate control have different aims. Your clinician considers kidney function, other medicines and attack history before selecting treatment.
Classification is not diagnosis. A low score does not rule out disease. Do not arrange every listed test or start, stop or change medicines based on this result; your clinician decides what is needed.
Clinical references: 2015 ACR/EULAR criteria and definitions · ACR patient guide: gout