Gout Diagnosis

How is gout diagnosed?

Gout is diagnosed when uric acid is found in the synovial fluid. Diagnosing gout usually takes place when an attack is occurring. Your doctor must remove synovial fluid from the inflamed area and order tests to determine the levels of uric acid.

Uric acid is a waste product that occurs naturally when your body breaks down certain proteins. Too much of it causes needle-like crystals to form that can inflame cartilage, bones, ligaments and other joint tissues. Evidence of this build up shows in the synovial fluid, which is why it is collected as part of the diagnostic process.

While the procedure to collect fluid only takes seconds, it can be painful.  The skin surrounding a gout-inflamed joint is often very sensitive.

The gold standard of diagnosing gout requires removing synovial fluid from the joint with a needle. (Source: 123RF)

 Other Diagnostic Options for Gout

Testing synovial fluid is the standard for diagnosing gout, but another option for getting a gout diagnosis is through a blood test. Your doctor would get a sample of blood to have the levels of creatinine and uric acid tested. While a viable alternative to joint fluid collection, this option does have its downsides. Some people can have high levels of uric acid but not enough to experience gout. At the same time, people with physical signs of gout may not have high levels of uric acid in their blood.  In some academic centers with appropriate expertise, ultrasonography of the joint with guided aspiration may help to diagnose; a dual-energy CT scan (DECT) of the affected joint is also available in some centers to diagnose gout.

Some physicians may use other methods based on criteria developed by the American College of Rheumatology and adopted by the American Academy of Family Physicians.

For instance, doctors are likely to diagnose gout if you have six or more of the following symptoms:

  • lopsided joint swelling on an x-ray
  • blood test showing high uric acid levels
  • joint fluid culture negative for organisms during a gout attack
  • maximum joint inflammation developed within a day
  • arthritis in only one joint
  • more than one attack of acute arthritis
  • painful/swollen first big toe joint
  • redness over joints
  • x-rays that identify subcortical cysts without erosions
  • tophi (bumps caused by uric acid deposits)
  • a gout-like attack of on both big toe joints at the same time
  • a gout-like attack on both ankle joints at the same time.

The Importance of Obtaining an Official Diagnosis of Gout

Gout shares many common symptoms with joint infections and other types of arthritis, and it requires special treatment. By getting an accurate diagnosis of gout, you and your doctor can start working on effective treatments to stop the gout attack and recover.

Updated on: 02/12/19
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