A systematic review of the diagnosis of acute gout1 was published recently, containing an earlier study from primary care2 with similar findings.
A clinical score was derived from the odds ratios – highest to lowest correlation:
Clinical score
| Serum uric acid > 0.36 mmol/l * (5.88 mg/dL) | 3.5 |
| First MTP joint involvement | 2.5 |
| Male gender | 2.0 |
| Previous patient-reported arthritis attack | 2.0 |
| Hypertension or ≥ 1 CV diseases | 1.5 |
| Joint redness | 1.5 |
| Onset within one day | 1.0 |
| Maximum score | 13.0 |
*N.B. uric acid may be low during an acute attack so a blood test 4 or more weeks after an acute attack should be used.
A score of 8 or more meant gout was confirmed in 80% of cases. In New Zealand, a patient of Māori or Pacific ethnicity would have a higher chance of having gout when presenting with unilateral joint pain, given their very high prevalence of gout.
By age 65 more than 1 in 4 Māori and Pacific men will be on allopurinol for gout.3
References
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