How Is Gout Diagnosed

There are a number of conditions that can cause swelling, throbbing, painful red joints – the most common symptoms of gout. It can be any of the following types of arthritis: osteoarthritis, rheumatoid arthritis, pseudogout or even joint infection (septic arthritis). It is important to get the diagnosis right as gout is a chronic disease, and if left untreated, it can cause long-term damage to the joints and kidneys; not to mention the physical pain of recurring gout attacks and the cost and danger involved in taking the wrong medications.

Most literature on gout says that there is not one definitive test for gout. Rather, gout diagnosis is a combination of the following steps:

Determining patient’s history.  Gout has many risk factors including gender, genetics or family history, obesity and weight, diet and lifestyle or pre-existing medical conditions such as vascular disease. Leading cause of secondary gout is side effects from medication treating vascular diseases like hypertension.

Serum Uric Acid. This simply means testing the uric acid level in the blood. The most surprising thing is that during acute attacks (the time when your joints are swelling and painful), the uric acid level determined from this test is usually not elevated! This is why this test is carried out four to six weeks after an acute attack has subsided. A uric acid level significantly higher than what is considered normal (less than 6mg/dL) is one indication of gout. However, this is not definitive as a lot of people can have elevated uric acid levels but don’t develop gout. This brings us to another diagnostic tool that is more definitive.

Synovial fluid. This simply means drawing out fluid sample from a swollen joint and examining it under a microscope for uric acid crystals. This may sound painful but this is a very useful test as it also helps rule out joint infection.

X-ray is used not to confirm gout but to rule-out pseudogout, caused by build-up of calcium crystals in the joints, which are visible in an x-ray.

Checklist of symptoms. A lot of doctors also use a checklist in conjunction with the tests above or in patients where synovial fluid exam is too painful or not possible, as gout symptoms are known to occur in a certain pattern. It is then useful for a patient to accurately describe the symptoms and their occurrence. A checklist can contain the following items:

 How is Gout Diagnosed – checklist

1.  Having more than one attack of the symptoms of pain and inflammation.
2.  Experiencing severe inflammation within one day of the on-set of the symptoms.
3.  Joints in big toes have been affected.
4.  Other joints in the feet or extremities have been affected.
5.  Symptoms affecting one joint at a time.
6.  High uric acid level from blood test.
7.  No evidence of bacteria in joint.
8.  Physical exam or X-ray reveals joint inflammation.

Six yes answers usually results to a diagnosis of gout.

Finally, another clear indication of gout is response to gout medication. If your gout symptoms are eliminated with uric acid lowering drugs known to specifically target gout, like Allopurinol, then it seems certain you have gout. Be relentless in pursuing the correct diagnosis.