Acute Gout Diagnosis Rule

This helps to risk stratify for gout vs non-gout arthritis and helps determine which patients benefit most from joint aspiration.  However, be careful…. recent research shows that the gout calculator is not sufficient on its own to discriminate between gout and septic arthritis!!!

Male sex

  • No         0
  • Yes     +2

Previous patient-reported arthritis attack

  • No         0
  • Yes     +2

Onset within 1 day

  • No         0
  • Yes     +0.5

Joint redness

  • No         0
  • Yes     +1

1st metatarsophalangeal joint involvement

  • No         0
  • Yes     +2.5

Hypertension or ≥1 cardiac diseases
Angina, MI, CHF, Stroke/TIA, PVD

  • No         0
  • Yes      +1.5

Serum uric acid > 5.88 mg/dL (0.35 mmol/L)

  • No         0
  • Yes     +3.5


  • Score of 4 or less: Gout unlikely and other diagnoses should be considered.  2.2% prevalence of gout in original study.
  • Scores from >4 and <8 are equivocal. These patients often benefit the most from synovial fluid analysis for crystals.  31.2% prevalence of gout
  • Scores of 8 or more: 82.5% prevalence of gout in original study.  Gout is very likely.


Hein J. E. M. Janssens, MD, is a researcher in the Department of Primary and Community Care, Radboud University Nijmegen Medical Center, in Nijmegen, the Netherlands. He practices in the fields of internal medicine, primary care and rheumatology.


The Gout-calculator may not be sufficient enough, to replace arthrocentesis for synovial fluid analysis, for the diagnosis of gout or to exclude the possibility of septic arthritis in patients with acute arthritis, according to study results published in Clinical Rheumatology.

Key Points:
• For a Gout-calculator threshold of ≤ 4, Sensitivity is 92.5%, Specificity 50.8% and LR− 0.15 to the gout diagnosis.
• For a Gout-calculator threshold of > = 8, Sensitivity is 27.5%, Specificity 97.7% and LR+ 11.9 to the gout diagnosis.
• In a population of acute arthritis affecting large joints, Gout-calculator is not sufficient to discriminate between gouty arthritis and septic arthritis.

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