Diagnosis of gout

The article was written by MSc Bui Minh Duc - Head of General Internal Medicine Unit, Department of General Internal Medicine - Vinmec Times City International General Hospital.

The onset of gout pain is usually limited to one joint, and gout is more likely if the pain begins in the big toe. Polyarticular gout usually involves other joints in the legs or lower feet, but can involve the elbows, wrists, or hands.

60% of gout attacks first appear in the big toe. There may be a similar pain three months ago in the patient's right toe. This may be the patient's first acute episode.
Associated symptoms include:
Swelling near and outside the affected joint Red or shiny skin Mild fever or chills Loss of appetite

Patients with gouty polyarthritis are more likely to present with fever, chills, or loss of appetite.

Acute gout attacks can occur in many joints at different times or in many joints at the same time. If acute or chronic gout is suspected, a serum uric acid test may be performed. Low serum uric acid levels make the diagnosis of gout less likely, but hyperuricemia and joint pain do not confirm gout.
During an acute gout flare, a patient can paradoxically have normal or even low uric acid levels. Suspected gout may warrant referral to a rheumatologist for the treatment of joint disease. The test to confirm or rule out gout is aspiration and examination of the synovial fluid of a painful swollen joint for uric acid crystals.
Even in the setting of classic hyperuricemia or joint swelling, when no synovial fluid is available, other conditions should be ruled out. Osteoarthritis, septic arthritis, pseudogout (caused by calcium pyrophosphate crystals), and other rheumatic autoimmune diseases can all mimic gout.
The American College of Rheumatology outlines the criteria for gout. Gout can be diagnosed if one of the following is present:
Monosodium urate crystals in Tophi synovial fluid confirmed by crystallographic examination

If at least six of the following criteria are identified, gout can also be diagnosed:
Asymmetric swelling in the joint on radiograph Arthritis - first finger (Typical) Hyperuricemia More than one attack of inflammation acute joint swelling and redness of the joint Subcortical cyst without radiographic erosion Tophi suspicion Suspicion of synovial fluid culture is negative for organisms in an acute gout attack First metatarsophalangeal pain Single joint pain

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