Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.

Academic Rheumatology Nottingham University Nottingham UK

Academic Rheumatology University of Nottingham Nottingham UK

AP HP Hôpital Pitié Salpêtrière Département Biostatistique Santé Publique et Information Médicale Centre de Pharmacoépidémiologie INSERM UMR 1123 ECEVE CIC 1421 Paris France Paris France

Arthritis Research UK Primary Care Centre Keele University Keele UK

Biostatistics and epidemiology APHP Hopital Pitié Salpetrière Paris France

Centre Molecular Medicine University of Edinburgh Edinburgh Scotland UK

Département d'Epidémiologie et Recherche Clinique Paris France

Department of Internal Medicine Section of Rheumatology University Clinic Carl Gustav Carus Dresden Saxonia Germany

Department of Medicine University of Padua Padua Italy

Department of Primary and Community Care Radboud University Medical Center Radboud Institute for Health Sciences Nijmegen The Netherlands

Department of Rhumatologie Hôpital Lariboisière Paris France

INSERM UMR 1132 and Université Paris Diderot Paris France

Inserm UMR1132 Bioscar Universite Paris Diderot UFR de Medecine Paris France

Institute of Rheumatology Prague Czech Republic Czech Republic

Institute of Rheumatology RAMS Moscow Russian

Musculoskeletal Medicine Service de RMR Lausanne Switzerland

Nottingham UK

Radiology Lausanne University Hospital Lausanne Switzerland

Rheumatology Assistance Publique Hopitaux de Paris Paris France

Rheumatology Diakonhjemmet Hospital Oslo Norway

Rheumatology Hospital General Universitario de Alicante Alicante Spain

Rheumatology Unit Clínica Coração de Jesus Lisbon Portugal

Rheumatology VieCuri Venlo Netherlands

Service de Rhumatologie Hopital Lariboisiere Centre Viggo Petersen Paris France

Servicio de Reumatologia Hospital de Cruces Baracaldo Spain

Nat Rev Rheumatol. 2019 Oct;15(10):578-580. doi: 10.1038/s41584-019-0286-7. PubMed

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