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2015 ACR/EULAR Gout Classification Criteria

For patients with at least one episode of peripheral joint or bursa swelling, pain or tenderness, MSU crystals in synovial fluid or a tophus classify gout outright; otherwise a weighted score of clinical, serum urate and imaging items is summed (range −6 to 23), and ≥8 classifies as gout (sensitivity 92%, specificity 89%).

  • Synovial fluid / tophus aspirate for MSU crystals: Not done (0); MSU negative (symptomatic joint/bursa) (-2); MSU positive (sufficient criterion)
  • Joints/bursae involved in symptomatic episode(s) ever: Other joints/bursae only, or ankle/midfoot/1st MTP only as part of a polyarticular presentation (0); Ankle or midfoot (mono/oligoarticular) without 1st MTP (1); First MTP joint (mono/oligoarticular) (2)
  • Erythema overlying the affected joint (ever) (yes/no, +1)
  • Can't bear touch or pressure to the affected joint (ever) (yes/no, +1)
  • Great difficulty walking or inability to use the affected joint (ever) (yes/no, +1)
  • Typical episodes (≥2 of: max pain <24 h, resolution ≤14 days, complete resolution between episodes): No typical episodes (0); One typical episode (1); Recurrent typical episodes (2)
  • Clinical tophus (draining or chalk-like subcutaneous nodule in a typical location) (yes/no, +4)
  • Serum urate (highest off urate-lowering therapy) (mg/dL or µmol/L or mmol/L)
  • Imaging urate deposition: ultrasound double-contour sign or DECT urate (not done = no) (yes/no, +4)
  • Radiographic gout erosion of hands/feet (not done = no) (yes/no, +4)
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Interpretation

ResultMeaning
MSU crystals presentGout (sufficient criterion)
≥ 8Classified as gout
< 8Not classified as gout

Formula

Entry: ≥1 episode of peripheral joint/bursa swelling, pain or tenderness. Sufficient: MSU crystals in symptomatic joint/bursa or tophus. Otherwise sum: joint pattern (ankle/midfoot 1, 1st MTP 2) + episode characteristics (erythema, can't bear touch, great difficulty walking: 1 each) + time course (1 typical episode 1, recurrent 2) + tophus 4 + serum urate (<4 mg/dL −4; 4–<6: 0; 6–<8: 2; 8–<10: 3; ≥10: 4) + synovial fluid MSU negative −2 + imaging urate deposition 4 + radiographic erosion 4. Gout if ≥8.

Clinical pearls

  • These are classification criteria for research enrolment; in practice, joint or tophus aspiration remains the diagnostic standard.
  • Score the highest serum urate on record, ideally off urate-lowering therapy and more than 4 weeks after an episode starts; urate can be normal during a flare.
  • Imaging and synovial fluid items score 0 when not performed, so the criteria still work clinically (clinical-only sensitivity 85%, specificity 78%).

Examples

gout criteria: podagra, red, can't bear touch, difficulty walking, recurrent typical episodes, uric acid 9acr eular gout ankle swelling one episode erythema only urate 7 mg/dLis this gout: first mtp, recurrent attacks, tophus, urate 3.5, no aspirate

FAQ

What score classifies gout under the 2015 ACR/EULAR criteria?

A total of 8 or more (out of a maximum of 23) classifies a patient as having gout, unless MSU crystals were already seen, which is sufficient on its own.

Can a low uric acid rule out gout?

It lowers the probability: a serum urate below 4 mg/dL (0.24 mmol/L) subtracts 4 points, but urate can fall during an acute attack, so retest between attacks.

Evidence

  1. Neogi T et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2015;74:1789–98.
  2. Neogi T et al. 2015 Gout classification criteria. Arthritis Rheumatol 2015;67:2557–68.

Endocrine & Metabolic · Reviewed 2026-10-14 · Methodology