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How recently were you diagnosed with gout?

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Diagnosis

A diagnosis of gout will usually involve both a medical evaluation (a combination of a physical examination and talking with your doctor) and laboratory tests to confirm the diagnosis.

Medical Evaluation

If you are able to see your doctor while you are having symptoms that might be related to gout (for example, pain and swelling in your big toe), the first step is a discussion with your doctor. Your doctor will ask you questions to help determine whether your problem is gout or something else, like a joint infection or another type of inflammatory arthritis, such as rheumatoid arthritis.

Your doctor may ask you about:

  • Your medical history;
  • What medications you are taking;
  • Your diet; and
  • The attack you’re experiencing, including how quickly it started, how bad the pain is, how many joints are affected and which specific joints are involved.

Diagnostic Tests

The surest way to diagnose gout is to check a sample of the joint’s fluid under a microscope to look for telltale needle-shaped crystals, which are commonly seen in gout patients.

A doctor may try to diagnose gout based on medical history, joint signs and symptoms. The key clue is intense pain in one lower-body joint that goes from none to excruciating within 12 hours (that’s when gout tackles you, not the other way around!)

But gout diagnosis can be tricky. A doctor needs to consider and rule out other types of inflammatory arthritis, like rheumatoid arthritis or psoriatic arthritis, pseudogout (which is caused by calcium pyrophosphate crystals – not the monosodium urate crystals that cause gout), infections and injury, so further tests may be needed to make a diagnosis, including:

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A blood test: If your uric acid level is high, you may have gout. But that isn’t always conclusive, because not everyone with high blood levels of uric acid has gout. And at certain times, even people with gout have normal blood levels of uric acid.

A sample of joint fluid: A sample of the fluid inside your joint may be taken out with a needle and examined under a microscope to look for crystals. Seeing crystals is the only sure way to confirm a gout diagnosis. A rheumatologist, or arthritis specialist, may do this test.

Imaging: Doctors sometimes use X-ray, ultrasound, CT or MRI to examine soft tissue and bone changes, but early changes may not show up. Advanced gout is easier to see in imaging.

How the joint fluid test works:

Your joint is a hinge where two bones meet. It’s encased in a synovial capsule, or tissue, and this capsule contains fluid where uric acid crystals accumulate and cause pain.

Part 1: The needle: To check for crystals inside your joint, your doctor will have to insert a sterile needle into the joint and remove a small amount of the fluid.

Part 2: The microscope: Your joint fluid will then be examined under a microscope for crystals.