Gout Diagnostic Score

Decision

Can this patient be diagnosed with gout without joint aspiration?

Population

Clinic, ER, Hospital

Components

Remember to always consider alternate diagnoses like septic arthritis if there is a concern for this ( systemic features, increased age, history of rheumatoid arthritis, skin infection, joint prosthesis, immunosuppression or atypical presentation)

If gout is suspected, use the following validated scoring system:

  • Male Sex (2 points)
  • Previous patient reported arthritis attach (2 points)
  • Onset within 1 day (0.5 points)
  • Joint redness (1 point)
  • Involvement of the 1st MTP joint (2.5 points)
  • Hypertension or >1 Cardiovascular diseases* (1.5 points)
    • angina/MI
    • CVA/TIA
    • heart failure
    • PVD
  • Serum uric acid >350 mmol/L (3.5 points)

Score

>8 points: Likelihood of gout is >87%, and joint aspirate is unnecessary for a considering management as per guidelinesĀ using NSAIDs, Colchicine, and urate lowering therapy where appropriate

Confirmation can always be performed with joint aspirate where appropriate (gold standard for definitive diagnosis)

Reference

  1. Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PM, van Weel C, Janssen M. A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. Arch Intern Med. 2010; 170: 1120-1126.