• Sydne J Newberry, John D FitzGerald, Aneesa Motala, Marika Booth, Margaret A Maglione, Dan Han, Abdul Tariq, Claire E O'Hanlon, Roberta Shanman, Whitney Dudley, and Paul G Shekelle.
• From RAND Corporation, Santa Monica, and David Geffen School of Medicine at the University of California and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
• Ann. Intern. Med. 2017 Jan 3; 166 (1): 27-36.

BackgroundAlternative strategies exist for diagnosing gout that do not rely solely on the documentation of monosodium urate (MSU) crystals.PurposeTo summarize evidence regarding the accuracy of clinical tests and classification algorithms compared with that of a reference standard of MSU crystals in joint aspirate for diagnosing gout.Data SourcesSeveral electronic databases from inception to 29 February 2016.Study Selection21 prospective cohort, cross-sectional, and case-control studies including participants with joint inflammation and no previous definitive gout diagnosis who had MSU analysis of joint aspirate.Data ExtractionData extraction and risk-of-bias assessment by 2 reviewers independently; overall strength of evidence (SOE) judgment by group.Data SynthesisRecently developed algorithms including clinical, laboratory, and imaging criteria demonstrated good sensitivity (up to 88%) and fair to good specificity (up to 96%) for diagnosing gout (moderate SOE). Three studies of dual-energy computed tomography (DECT) showed sensitivities of 85% to 100% and specificities of 83% to 92% for diagnosing gout (low SOE). Six studies of ultrasonography showed sensitivities of 37% to 100% and specificities of 68% to 97%, depending on the ultrasonography signs assessed (pooled sensitivity and specificity for the double contour sign: 74% [95% CI, 52% to 88%] and 88% [CI, 68% to 96%], respectively [low SOE]).LimitationImportant study heterogeneity and selection bias; scant evidence in primary and urgent care settings and in patients with conditions that may be confused with or occur with gout.ConclusionMultidimensional algorithms, which must be validated in primary and urgent care settings, may help clinicians make a provisional diagnosis of gout. Although DECT and ultrasonography also show promise for gout diagnosis, accessibility to these methods may be limited.Primary Funding SourceAgency for Healthcare Research and Quality. (Protocol registration: https://effectivehealthcare.ahrq.gov/ehc/products/564/1937/gout-protocol-140716.pdf).

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