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7 points for clinical diagnosis of gout without joint fluid analysis

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

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