Gout Diagnosis Calculator (ACR/EULAR 2015 + Acute Rule)

Your details

Entry criterion: at least one episode of swelling, pain, or tenderness in a peripheral joint or bursa

Sufficient criterion: MSU crystals confirmed in synovial fluid or tophus by polarised-light microscopy

Pattern of joint or bursa involvement during symptomatic episodes

Characteristics present during episodes (erythema, extreme tenderness to touch, difficulty walking or using the joint)

Time course of episodes (maximal pain within 24 h, resolution within 14 days, complete resolution between attacks)

Clinical evidence of tophus (draining or chalk-like subcutaneous nodule in a typical location)

Serum urate level (uricase method, taken when patient NOT on urate-lowering therapy)

Synovial fluid analysis of a symptomatic joint or bursa

Imaging evidence of urate deposition in symptomatic joint (ultrasound double-contour sign or DECT urate deposits)

Imaging evidence of gout-related joint damage (at least one erosion on X-ray)

Male sex

Previous patient-reported arthritis attack

Onset within 1 day (attack reached maximal severity within 24 hours)

Joint redness (erythema overlying the affected joint)

1st metatarsophalangeal joint involved (big toe)

Hypertension or 1 or more cardiovascular diseases (angina, MI, CHF, stroke/TIA, peripheral vascular disease)

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

2015 ACR/EULAR ScoreClassified as Gout

Score >= 8 classifies as gout (sensitivity 92%, specificity 89%)

ACR/EULAR ClassificationClassified as GOUT (score >= 8)

Acute Gout Diagnosis Rule Score9.5

Acute Rule InterpretationGouty arthritis very likely - empiric gout treatment may be appropriate

Maximum possible ACR/EULAR score23

9 points

Very unlikely<0Low likelihood0-4Borderline4-8Classified as gout8-15Strongly classified15+

Gout is classified based on the criteria entered.

Your ACR/EULAR score is 9 out of a maximum of 23. A score of 8 or higher classifies gout with 92% sensitivity and 89% specificity.
The Acute Gout Diagnosis Rule score indicates gout is very likely. Empiric urate-lowering or anti-inflammatory treatment may be clinically appropriate pending specialist review.
Even with a classifying score, joint aspiration to confirm MSU crystals remains the gold standard where clinically feasible.

Next stepDiscuss urate-lowering therapy targets (serum urate below 6 mg/dL, or below 5 mg/dL in severe cases) and acute attack management with a rheumatologist or treating physician.