Gout Diagnosis

Gout diagnosis requires the analysis of both clinical features and investigations. Here on this page we will look into the investigations part. Laboratory tests that are done in gout to confirm the diagnosis include the following

  • Analysis of the joint (synovial) fluid under the microscope.
  • Blood levels of uric acid.

During acute gout synovial fluid is removed from the inflamed joint with the help of a syringe and needle. This fluid is then examined under a microscope in the presence of polarized light. Under this light needle like birefringent crystals of mono-sodium urate can be seen. Excessive precipitation of crystals can make the synovial fluid paste like.

The crystals may also be seen in the joint fluid of the knee and metatarso-phalangeal joint of the great toe (joint of the ball of foot) in between the acute attacks.

x ray of gouty arthritis

Blood levels of uric acid can be normal or low during a acute episode of gout. This is because the chemical mediators of inflammation in the body (called cytokines) can cause a increased excretion of uric acid. The blood levels can be tested again once the acute attack has subsided.

Urine collected over 24 hours can be helpful to determine if there is a over production of uric acid. If there is a excretion of more than 800mg of uric acid per day on a regular diet then this indicates the possibility of over production of uric acid.

X rays of the involved joint taken during acute gout are normal. With repeated attacks there is loss of joint space, bone spur (red arrows in the x ray graphic)formation and areas of decreased calcification can be seen. Bone spurs in gout are comparatively larger than in other joint diseases.

Other general investigations such as serum creatinine, haemoglobin, urine analysis, c reactive protein, cell counts, erythrocyte sedimentation rate and serum lipids are useful to rule out risk factors and assess general health.

I hope you found the information on this page useful. If you have any query you can ask me at the contact me page.

This page was last updated on 13th November 2008

More on Gout...

Cause of Gout

Gout Symptoms

Gout Treatment

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