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Gout Diagnosis

The goal of this video presentation is to provide practical information physicians can use during an initial patient assessment for gout.

Risk factors for gout include:

  • Obesity
  • Age
  • Decreased renal function

Often allodynia is the chief complaint when gout affects the large toe. Although gout can affect other joints, the incidence is lower. Gout affecting other joints will come on quickly and very acutely with intense redness, warmth, and usually in the middle of the night. When arthritis presents as acute, gout should be considered.

The ideal way to diagnose gout is the presence of monosodium urate (MSU) crystals within the joint, which requires the physician to aspirate synovial fluid for microscopy. Sometimes uric acid levels fall during the gout attack. Therefore, it may be recommended to check levels at other times. It is important to monitor uric acid, renal function, and obtain a basic metabolic panel.

Pseudogout is another form of arthritis, and it can occur in any joint (eg, knee), but less commonly in the large toe.

Other facts about pseudogout:

  • Often affects the wrists and small joints of the hands
  • Occurs more frequently in the elderly
  • Clinically, resembles gout
  • Mimics gout but without elevated MSU
  • An x-ray may detect deposits of Calcium Pyrophosphate or calcification of the cartilage in joints
First published on: November 11, 2013