Diagnosing Gout.
The diagnosis of gout or gouty arthritis as it is also called, is based on a series of investigations which confirm the presence of gout. Most of the times, the symptoms of gout are enough for your doctor to more or less confirm the diagnosis of gout. But laboratory tests for gout are needed to erase any lingering doubt of diagnosis of gout. There are more than 200 forms of arthritis which cause pain, swelling and inflammation of joints.
How is gout diagnosed.
The main differential diagnosis of gouty arthritis include rheumatoid arthritis, pseudo gout which is again a crystal induced arthritis, psoriatic arthritis, arthritis due to bacterial infection and systemic lupus. Rheumatoid arthritis and systemic lupus attack more than one joint while gout usually attacks one joint at one time.
Tests for Gout.
1) Blood Test for Gout.
Blood serum is tested for uric acid levels. Rise in uric acid levels along with the typical gout symptoms is strongly suggestive of presence of gout. However, uric acid levels may be normal even during a gout attack or there may be raised uric acid levels without presence of gout. It may take four to six weeks after a gout attack for uric acid levels to rise. Do read gout, to know about normal serum uric acid levels.
2) Urine Test for Gout.
A 24 hour sample of urine is collected to measure uric acid levels. A rise in uric acid levels in urine is suggestive of excessive production of uric acid in the body. A fall in uric acid levels is suggestive of improper functioning of the kidneys. Gout can be due to both these reasons. Therefore any abnormality of urine uric acid levels along with gout symptoms can be suggestive of gout. Any kidney stones (which are seen sometimes associated with gout) formed as a result of high serum uric acid levels will also be detected by urine tests, which will show crystals of monosodium urate. For normal levels of urine uric acid levels do read gout.
3) X ray for diagnosis of gout.
In the early stages of gout, x ray of the affected joint does nothing but rule out other causes of pain and swelling of the joints, besides gout. X ray will show soft tissue swelling which is even otherwise seen by naked eye. In chronic cases of gout, x ray of the affected joint may show crystal deposits and damaged bones and cartilage caused by repeated gout attacks.
4) Testing joint fluid to diagnose gout.
Needle Aspiration for Gout. This is the only sure shot diagnostic method to confirm diagnosis of gout. In the joints, there is the synovial fluid inside the synovial sac, which acts as a lubricant to facilitate joint movements. This joint fluid is aspirated using a fine needle and syringe and tested for presence of monosodium urate crystals ( derivatives of uric acid). Sometimes in an acutely swollen and painful condition, this test may not be possible.
Picture of needle aspiration biopsy for gout diagnosis.
Summary of gout diagnosis:
Diagnosis of gout can be confirmed as follows.
- Serum uric acid levels are high.
- Urine uric acid levels are not within the normal range. They may be either raised or lowered as explained above.
- X ray shows crystal deposits and/or damaged bones and cartilage.
- Synovial fluid shows presence of uric acid crystals.
- Symptoms show that only one joint is affected.
- Symptoms and signs of gout are similar to the ones explained in gout symptoms.
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