Classification Criteria for Gout

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In the MD Insights program “The ‘Disease of Kings:’ Addressing Misperceptions and Treating Gout Effectively Now and in the Future,” Theodore R. Fields, MD, professor of clinical medicine at Weill-Cornell Medical College, and director of the Rheumatology Faculty Practice Plan at Hospital for Special Surgery, discusses gout diagnosis, misperceptions about the disease, and the consequences of undertreatment of this condition. He also reviews current gout treatment options and discusses potential future treatments.

According to Dr. Fields, the ACR is in the process of developing new diagnostic classification criteria for gout. The goal is to have a resource that would enable a physician to make a diagnosis of gout even when they cannot get crystal identification. This is particularly important for primary care because often the patient is not going to have crystals identified.

As part of the criteria creation process, researchers conducted a study involving patients with crystal-identified gout and sought to determine if they shared common features that associate with a true diagnosis of gout.

Dr. Fields said that dual energy CT scanning has good sensitivity and specificity for diagnosing gout, and can be used in patients from whom the treating physician is unable to obtain crystals (for example, the patient may refuse to allow his or her joints to be tapped). CT scanning also valuable because it allows the physician to distinguish between gout and similarly presenting conditions, such as hydroxyapatite.