Interactive scorer
Try an example:
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Per-domain breakdown
| Domain | Points |
|---|
Positive points push toward classification; negative points (low serum urate, MSU-negative aspirate) weigh against gout. Maximum possible total: 23.
Scoring reference — ACR/EULAR 2015 (Neogi et al.)
Step 1 — entry criterion: at least 1 episode of swelling, pain, or tenderness in a peripheral joint or bursa. Only apply the criteria below to those meeting it.
Step 2 — sufficient criterion: presence of MSU crystals in a symptomatic joint or bursa (synovial fluid) or tophus. If met, classify as gout without further scoring.
Step 3 — scoring (maximum 23; ≥8 classifies as gout):
| Domain | Category | Score |
|---|---|---|
| Pattern of joint/bursa involvement | Ankle or midfoot (mono-/oligoarticular, no MTP1) | 1 |
| First MTP joint (mono-/oligoarticular) | 2 | |
| Characteristics of episode(s) ever erythema · can’t bear touch · great difficulty walking | One characteristic | 1 |
| Two characteristics | 2 | |
| Three characteristics | 3 | |
| Time course of episode(s) ever typical = <24 h to max pain, ≤14 days resolution, complete resolution between episodes | One typical episode | 1 |
| Recurrent typical episodes | 2 | |
| Clinical evidence of tophus | Present (draining/chalk-like nodule, typical locations) | 4 |
| Serum urate (highest on record, mg/dL) | <4 | −4 |
| 4–<6 | 0 | |
| 6–<8 | 2 | |
| 8–<10 | 3 | |
| ≥10 | 4 | |
| Synovial fluid MSU examination | Negative (symptomatic joint/bursa, trained observer) | −2 |
| Imaging: urate deposition | Present — ultrasound double-contour sign or DECT urate | 4 |
| Imaging: gout-related joint damage | Present — radiographic erosion | 4 |
Sensitivity 92%, specificity 89% in the independent validation dataset (Neogi et al., Arthritis & Rheumatology 2015;67(10):2557–68).
Interpretation guide
| Total score | Interpretation |
|---|---|
| ≥ 8 | Classifies as gout (ACR/EULAR 2015). Still a classification, not a clinical diagnosis — confirmation by crystal identification is the gold standard. |
| 5 – 7 | Intermediate zone. Does not classify as gout. Reassess clinically; missing data (e.g., imaging not performed) may be hiding points. |
| 0 – 4 | Does not classify as gout. Consider alternative diagnoses (septic arthritis, pseudogout/CPPD, reactive arthritis, RA). |
| < 0 | Does not classify as gout. Negative scores come from serum urate <4 mg/dL and/or MSU-negative aspirate — both weigh strongly against gout. |
Points that commonly change the result
- Serum urate <4 mg/dL (−4): a single low value can erase an otherwise classic presentation. Measure off urate-lowering therapy and >4 weeks after an episode starts; acute flares can transiently lower urate.
- MSU-negative aspirate (−2): only counts from a symptomatic joint or bursa examined by a trained observer. MSU-positive fluid is the sufficient criterion — no scoring needed.
- Imaging (+8 possible): double-contour sign/DECT and radiographic erosion are the heaviest-weighted domains; unperformed imaging is scored 0, so incomplete workup understates the score.
Sensible next steps
- Discuss the result with a rheumatologist — they can arrange joint aspiration for crystal proof.
- Bring your highest historical serum urate value and any imaging reports to the appointment.
- Do not start or stop urate-lowering therapy based on this score alone.
- Seek urgent care for a hot, acutely swollen joint with fever — septic arthritis is a medical emergency that can mimic gout.