Easy to misdiagnose
- R D Sturrock, professor of rheumatology
- Royal Infirmary, Glasgow G31 2ER
Gout is often thought to be relatively rare and therefore of not much interest to generalists. Yet it is an underdiagnosed condition that presents diagnostic and treatment challenges.
Various diagnostic criteria have been proposed for gout, depending on whether they are to be used in a clinical setting or for epidemiological surveys.1 The criteria proposed by Bennett and Wood in 19682 are still helpful in routine clinical practice. These are the presence of a clear history of at least two attacks of painful joint swelling with complete resolution within two weeks, a clear history or observation of podagra, the presence of a tophus, and a rapid response to colchicine within 48 hours of starting treatment.2 Two of these criteria are required for a clinical diagnosis, but a definitive diagnosis can be made if crystals of sodium monourate are seen in synovial fluid or in the tissues. Hyperuricaemia is a common but not obligatory feature, and it is important to realise that the serum …