Survey Definitions of Gout for Epidemiologic Studies: Comparison With Crystal Identification as the Gold Standard

Arthritis Care Res (Hoboken). 2016 Dec;68(12):1894-1898. doi: 10.1002/acr.22896. Epub 2016 Oct 28.


Objective: To identify the best-performing survey definition of gout from items commonly available in epidemiologic studies.

Methods: Survey definitions of gout were identified from 34 epidemiologic studies contributing to the Global Urate Genetics Consortium (GUGC) genome-wide association study. Data from the Study for Updated Gout Classification Criteria (SUGAR) were randomly divided into development and test data sets. A data-driven case definition was formed using logistic regression in the development data set. This definition, along with definitions used in GUGC studies and the 2015 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) gout classification criteria were applied to the test data set, using monosodium urate crystal identification as the gold standard.

Results: For all tested GUGC definitions, the simple definition of "self-report of gout or urate-lowering therapy use" had the best test performance characteristics (sensitivity 82%, specificity 72%). The simple definition had similar performance to a SUGAR data-driven case definition with 5 weighted items: self-report, self-report of doctor diagnosis, colchicine use, urate-lowering therapy use, and hyperuricemia (sensitivity 87%, specificity 70%). Both of these definitions performed better than the 1977 American Rheumatism Association survey criteria (sensitivity 82%, specificity 67%). Of all tested definitions, the 2015 ACR/EULAR criteria had the best performance (sensitivity 92%, specificity 89%).

Conclusion: A simple definition of "self-report of gout or urate-lowering therapy use" has the best test performance characteristics of existing definitions that use routinely available data. A more complex combination of features is more sensitive, but still lacks good specificity. If a more accurate case definition is required for a particular study, the 2015 ACR/EULAR gout classification criteria should be considered.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Colchicine / therapeutic use
  • Diagnostic Self Evaluation
  • Epidemiologic Studies*
  • Female
  • Gout / classification*
  • Gout / urine
  • Gout Suppressants / therapeutic use
  • Humans
  • Hyperuricemia / classification
  • Hyperuricemia / urine
  • Logistic Models
  • Male
  • Sensitivity and Specificity
  • Symptom Assessment / methods*
  • Uric Acid / urine


  • Gout Suppressants
  • Uric Acid
  • Colchicine