What's most important in diagnostics of gout

What in your opinion is most important in the diagnostics of gout? Which of the available diagnostic criteria seem most useful?

George Nuki: I think one still needs to bear in mind that the gold standard for the diagnosis of gout is the crystal identification. Clearly, this is not always practical in primary care. The guidelines which are currently being updated by the European League Against Rheumatism (EULAR), but which dated originally from 2005, are very good, looking at how effective the different modalities are.

I think ultrasound has also made a big difference, but again this is predominantly going to be in hospital practice. Certain aspects of ultrasound in gout are particularly useful. The double contour sign is not quite as sensitive as one would wish, but it really has quite good specificity, whereas some of the other features that one can see in patients with gout have much less specificity – a positive Doppler study and so forth.