rheumatology

2015 ACR/EULAR Gout Classification Criteria

2015 ACR/EULAR classification criteria for gout. Based on clinical, laboratory, and imaging evidence. Score ≥8 = gout classified. Gold standard = urate crystals in joint fluid, but scoring system available when unavailable.

Used in: Gout

Pattern of joint involvement — involvement of MTP1 (first metatarsophalangeal joint)*

Characteristics of symptomatic attack — erythema (1), can't bear touch/pressure (1), difficulty walking (1) — count features*

Time course — recurrent typical acute attacks (2 attacks), peak within 24h (1), resolution in ≤14 days (1), complete resolution between attacks (1)*

Clinical evidence of tophus (draining or chalk-white subcutaneous nodule under transparent skin)*

Serum urate (mmol/L) — measured at time of attack/remission*

Synovial fluid analysis of symptomatic joint — MSU crystals*

Imaging evidence of urate deposition (USS double contour sign or DECT urate deposition)*

X-ray evidence of gout-related joint damage (cortical erosion with sclerotic margin/overhanging edge)*

Score interpretation

Gout Not Classified 0–7

Score <8 — gout classification criteria not met

→ Consider alternative crystal arthropathy (CPPD, hydroxyapatite), septic arthritis, psoriatic arthritis; aspirate joint if possible; if clinically suspicious, repeat urate level during attack; rheumatology referral

Gout Classified 8–99

Score ≥8 — gout classified

→ Acute attack: colchicine 0.5 mg BD or NSAIDs (indometacin 50 mg TDS) or prednisolone 30–35 mg/day; avoid aspirin (raises urate). Urate-lowering therapy (ULT): start allopurinol after acute attack resolves; target urate <0.36 mmol/L (0.30 mmol/L if tophi); titrate allopurinol from 100 mg (50 mg in renal impairment); cover ULT initiation with colchicine prophylaxis 3–6 months; lifestyle: reduce alcohol, high-fructose foods, red meat

Interpretation bands for the 2015 Gout Criteria. Apply clinical judgement and local guidance.

References

Neogi T et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2015;74(10):1789–1798.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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