Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis.
BACKGROUND
Several classification or diagnostic criteria sets for gout have been proposed but none validated.


OBJECTIVE
This small pilot study considered urate crystal identification as the gold standard for diagnosis and compared the clinical aspects of 3 proposed criteria sets with that standard.


METHODS
Eighty-two subjects who had synovial fluid analyses in a VA medical center were studied. ARA (ACR), Rome, and New York clinical criteria sets and individual criteria were recorded in the 30 patients who had urate crystals versus the remainder with no urate crystals.


RESULTS
Presence of 2 of 3 Rome clinical criteria had the highest positive predictive value at 76.9%. None of the 3 studied criteria sets were more than 70% sensitive or 88.5% specific. The clinical features of the ARA (ACR) preliminary classification criteria had 70% sensitivity and 78.8% specificity.


CONCLUSIONS
The various proposed clinical criteria can provide support for a diagnosis or exclusion of gout, but unless improved criteria can be developed crystal identification should remain the gold standard.
Malik
Aarti
A
University of Pennsylvania, VA Medical Center, Philadelphia, Pennsylvania, USA. aarti_malik14@hotmail.com
Schumacher
H Ralph
HR
Dinnella
Janet E
JE
Clayburne
Gilda M
GM
D000368:Aged; D015331:Cohort Studies; D003460:Crystallization; D005260:Female; D006073:Gout / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D033461:Hyperuricemia; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013582:Synovial Fluid / Q000737:chemistry*; D014527:Uric Acid / Q000737:chemistry*
D014527:Uric Acid