Clinical Rheumatology

, Volume 31, Issue 3, pp 429–434 | Cite as

The diagnostic value of the proposal for clinical gout diagnosis (CGD)

  • Janitzia Vázquez-MelladoEmail author
  • Claudia B. Hernández-Cuevas
  • Everardo Alvarez-Hernández
  • Lucio Ventura-Rios
  • Ingris Peláez-Ballestas
  • Julio Casasola-Vargas
  • Sergio García-Méndez
  • Rubén Burgos-Vargas
Original Article


The purpose of this study is to determine the diagnostic properties of the clinical gout diagnosis (CGD) proposal in patients with gout and other rheumatic diseases. We investigated the presence of current or past history of the previously published CGD criteria: (1) >1 attack of acute arthritis, (2) mono/oligoarthritis attacks, (3) rapid progression of pain and swelling (<24 h), (4) podagra, (5) erythema, (6) unilateral tarsitis, (7) probable tophi, and (8) hyperuricemia. CGD was established in patients with greater than or equal to four out of eight of these criteria. Demographic data and comorbidities were also considered. Statistical analysis included diagnostic test evaluation (sensitivity, specificity, likelihood ratios, positive predictive values and receiving operating characteristic curves). One hundred and sixty-seven patients with the following diagnoses were included: gout (most in intercritical period, n = 75), rheumatoid arthritis (RA, n = 30), osteoarthritis (OA, n = 31) and spondyloarthritis (SpA, n = 31). All gout patients had MSU crystal demonstration and constituted the gold standard for diagnostic test evaluation. There were significant differences across diagnostic groups in most demographic variables and comorbidity. The presence of greater than or equal to four out of eight of the CGD criteria were found in 97% patients with gout, in two patients with SpA, and one each with RA and OA. The sensitivity, specificity, and LR+ of greater than or equal to four out of eight of the CGD criteria were 97.3%, 95.6%, and 22.14, respectively. The presence of more than or equal to four out of eight items from the CGD proposal is highly suggestive of gout.


Diagnosis Gout Tophi Urate Uric acid 





  1. 1.
    McCarthy DJ, Hollander JL (1961) Identification of urate crystals in gouty synovial fluid. Ann Intern Med 54:452–460Google Scholar
  2. 2.
    Pascual E, Batlle-Gualda E, Martínez A, Rosas J, Vela P (1999) Synovial fluid analysis for diagnosis of intercritical gout. Ann Intern Med 131:756–759PubMedGoogle Scholar
  3. 3.
    Rouault T, Caldwell DS, Holmes EW (1982) Aspiration of the asymptomatic metatarsophalangeal joint in gout patients and hyperuricemic controls. Arthritis Rheum 25:209–212PubMedCrossRefGoogle Scholar
  4. 4.
    Carter JD, Kedar RP, Anderson SR, Osorio AH, Albritton NL, Gnanashanmugam S, Valeriano J, Vasey FB, Ricca LR (2009) An analysis of MRI and ultrasound imaging in patients with gout who have normal plain radiographs. Rheumatology (Oxford) 48:1442–1446CrossRefGoogle Scholar
  5. 5.
    Choi HK, Al-Arfaj AM, Eftekharis A, Munk P, Shojania K, Reid G, Nicolaou S (2009) Dual energy computed tomography in tophaceous gout. Ann Rheum Dis 68:1609–1612PubMedCrossRefGoogle Scholar
  6. 6.
    Puig JG, de Miguel E, Castillo MC, Rocha AL, Martínez MA, Torres RJ (2008) Asymptomatic hyperuricemia: impact of ultrasonography. Nucleosides Nucleotides Nucleic Acids 27:592–595PubMedCrossRefGoogle Scholar
  7. 7.
    Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yü TF (1997) Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 20:895–900CrossRefGoogle Scholar
  8. 8.
    Malik A, Schumacher HR, Dinnella JE, Cayburne GM (2009) Clinical diagnostic criteria for gout. J Clin Rheumatol 15:22–24PubMedCrossRefGoogle Scholar
  9. 9.
    Zhang W, Doherty M, Pascual E, Bardin T, Barskova V, Conaghan P et al (2006) EULAR evidence based recommendations for gout. Part I: diagnosis. Report of a task force of the standing committee for international clinical studies including therapeutics (ESCISIT). Ann Rheum Dis 65:1301–1311PubMedCrossRefGoogle Scholar
  10. 10.
    Taylor WJ, Schumacher HR Jr, Baraf HS, Chapman P, Stamp L, Doherty M, McQueen F, Dalbeth N, Schlesinger N, Furst DE, Vazquez Mellado J, Becker MA, Kavanaugh A, Louthrenoo W, Bardin T, Khanna D, Simon LS, Yamanaka H, Choi HK, Zeng X, Strand V, Grainger R, Clegg D, Singh JA, Diaz-Torne C, Boers M, Gow P, Barskova VG (2008) A modified Delphi exercise to determine the extent of consensus with OMERACT outcome domains for studies of acute and chronic gout. Ann Rheum Dis 67:888–891PubMedCrossRefGoogle Scholar
  11. 11.
    Janssens HJ, Janssen M, van de Lisdonk EH, Fransen J, van Riel PLCM, van Weel C (2010) The limited validity of the criteria of the American College of Rheumatology for classifying gout patients in primary care. Ann Rheum Dis 69:1255–1256PubMedCrossRefGoogle Scholar
  12. 12.
    Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M (2010) A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. Arch Intern Med 170:1120–1126PubMedCrossRefGoogle Scholar
  13. 13.
    Peláez Ballestas I, Hernández-Cuevas C, Burgos Vargas R, Hernández Roque L, Terán L, Espinoza J, Esquivel-Valerio JA, Goycochea Robles MV, Aceves FJ, Bernard AG, Ventura L, Shumsky C, Hérnandez Garduño A, Vázquez-Mellado J (2010) Diagnosis of chronic gout: evaluating the American College of Rheumatology proposal and European League against Rheumatism recommendations and clinical judgement. J Rheumatol 37:1743–1748PubMedCrossRefGoogle Scholar
  14. 14.
    Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324PubMedCrossRefGoogle Scholar
  15. 15.
    Altman R, Alarcón G, Appelrouth D et al (1990) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum 33:1601–1610PubMedCrossRefGoogle Scholar
  16. 16.
    Altman R, Asch E, Bloch G et al (1986) Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum 29:1039–1049PubMedCrossRefGoogle Scholar
  17. 17.
    Dougados M, van der Linden S, Juhlin R et al (1991) The European Spondyloarthropathy Study Group preliminary criteria for the classification of spondyloarthropathy. Arthritis Rheum 34:1218–1227PubMedCrossRefGoogle Scholar
  18. 18.
    Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert (2001) Panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 285:2486–2497CrossRefGoogle Scholar
  19. 19.
    The Expert Committee on the diagnosis and classification of Diabetes Mellitus (1999) Report of the Expert Committee on the diagnosis and classification of Diabetes Mellitus. Diabetes Care Suppl 2:4–19Google Scholar
  20. 20.
    Lioté F, Ea HK, Saraux A, Guggenbhul P, Aubert JP, Lantz S, Lambert C, Chiarelli P, Delva C, Lancrenon S (2010) A prospective survey of 1003 patients with gout: comparison between general practitioners and rheumatologists. Concordance of EULAR gout diagnostic criteria. The GOSPEL1000 study. Ann Rheum Dis Suppl 3:OP0197Google Scholar

Copyright information

© Clinical Rheumatology 2011

Authors and Affiliations

  • Janitzia Vázquez-Mellado
    • 1
    • 2
    • 4
    Email author
  • Claudia B. Hernández-Cuevas
    • 1
  • Everardo Alvarez-Hernández
    • 1
  • Lucio Ventura-Rios
    • 3
  • Ingris Peláez-Ballestas
    • 1
  • Julio Casasola-Vargas
    • 1
  • Sergio García-Méndez
    • 1
  • Rubén Burgos-Vargas
    • 1
    • 2
  1. 1.Rheumatology DepartmentHospital General de MéxicoMexico CityMexico
  2. 2.Faculty of MedicineUniversidad Nacional Autónoma de MéxicoMexico CityMexico
  3. 3.Rheumatology Department, Hospital General de Zona 194Instituto Mexicano del Seguro SocialMexico CityMexico
  4. 4.Servicio de ReumatologíaHospital General de MéxicoMexicoMexico

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