Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.

中文翻译：

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2018 年更新的欧洲抗风湿病联盟痛风诊断循证建议

虽然痛风是最常见的炎症性关节炎，但它仍然经常被误诊。自 2006 年第一次 EULAR 诊断痛风推荐以来，影像学和临床诊断的新数据已经可用。这促使对 2006 年推荐的系统回顾和更新。对有关痛风诊断各个方面的文献进行了系统回顾。建议是使用 Delphi 共识方法制定的。产生了八项关键建议。每个疑似痛风的人都建议在滑液或痛风石抽吸物中寻找晶体，因为尿酸钠 (MSU) 晶体的证明可以明确诊断痛风。一致认为许多提示性临床特征支持痛风的临床诊断。这些是足或踝关节（尤其是第一跖趾关节）的单关节受累；以前的类似急性关节炎发作；剧烈疼痛和肿胀的快速发作；红斑; 男性和相关的心血管疾病和高尿酸血症。当无法识别晶体时，建议任何非典型表现应通过成像进行调查，特别是通过超声来寻找暗示 MSU 晶体沉积的特征（双轮廓标志和痛风石）。共识是痛风的诊断不应仅基于高尿酸血症的存在。还强烈建议所有痛风患者都应系统地评估是否存在相关的合并症和心血管疾病的危险因素，以及慢性高尿酸血症的危险因素。提出了八项更新的、基于证据的、专家共识的痛风诊断建议。