In a meta-analysis on gouty involvement of the first MTP joint, the occurrence of acute first MTP arthritis has been reported to be an independent predictor of MSU crystal presence in patients with gout.6 The presence of first MTP arthritis and the predilection for MSU deposition in the medial and dorsal aspects of the joint suggested an association, but no causation, between the 2 disease processes. The authors concluded that the distinction between osteoarthritis and gout as the cause of the joint damage is often difficult.
The diagnosis of gout may be made clinically based on established clinical criteria. The most commonly used are the 1977 American College of Rheumatology (ACR) criteria for the classification of acute arthritis of primary gout. (See “The 12 diagnostic criteria for gout.”7) However, in 2015, the ACR/European League Against Rheumatism (EULAR) published a new set of criteria that include the signs and symptoms of chronic gout, as well.8 (The ACR-EULAR Gout Classification Criteria Calculator may be accessed at http://goutclassificationcalculator.auckland.ac.nz/.)
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The 12 diagnostic criteria for gout7
The 12 diagnostic criteria for gout7
1. Recurrent arthritic attack
2. Joint redness
3. Pain or swelling in the first metatarsophalangeal joint
4. Unilateral attack involving the first metatarsophalangeal joint
5. Unilateral attack involving the tarsal joint
6. Suspected tophus
7. Hyperuricemia
8. Radiographic evidence of asymmetric swelling within a joint
9. Attack of monoarticular arthritis
10. Development of maximal inflammation within one day
11. Negative culture of joint fluid for microorganisms during joint inflammation attack
12. Radiographic evidence of subcortical cyst without erosions