Apply the criteria only if the entry criterion is met (≥1 episode of peripheral joint or bursal swelling, pain or tenderness). Presence of monosodium urate (MSU) crystals in synovial fluid from a symptomatic joint or bursa, or in a tophus, is a sufficient criterion and classifies gout without further scoring.

If MSU crystals are not demonstrated, assign points and sum a total score (range approximately −6 to 23). A total score ≥8 classifies gout.

Domain	Item	Category	Score
Clinical	Pattern of joint/bursa involvement	Other pattern (eg polyarthritis or joints beyond ankle/midfoot/1st MTP)	0
		Ankle or midfoot only, mono- or oligoarticular, without 1st MTP	1
		1st MTP involved in mono- or oligoarticular episode	2
	Characteristics of symptomatic episode(s) ever	Erythema over joint, cannot bear touch or pressure, great difficulty walking or inability to use joint (1 point for each present)	0–3
	Time course of episode(s) ever	No typical episodes	0
		One typical episode (rapid onset, ≤14-day resolution, complete recovery between episodes)	1
		Recurrent typical episodes	2
	Clinical tophus	Present	4
Laboratory	Serum urate (highest value)	<0.24 mmol/L (<4 mg/dL)	−4
		0.24–<0.36 mmol/L (4–<6 mg/dL)	0
		0.36–<0.48 mmol/L (6–<8 mg/dL)	2
		0.48–<0.60 mmol/L (8–<10 mg/dL)	3
		≥0.60 mmol/L (≥10 mg/dL)	4
	Synovial fluid from symptomatic joint or bursa	MSU crystals not seen (MSU negative)	−2
Imaging	Urate deposition	Ultrasound double-contour sign or DECT urate deposition present	4
	Erosions	At least one typical gout erosion on hand/foot radiograph	4

ACR/EULAR Gout Classification Criteria