Materiały źródłowe

• #1 Gout Symptoms and Diagnosis | Johns Hopkins Arthritis Center

  https://www.hopkinsarthritis.org/arthritis-info/gout/clinical-presentation-of-gout/

  Gout is a form of arthritis, hence it causes pain and discomfort in the joints. […] A diagnosis of gout can be made with the documentation of the presence of uric acid crystals in synovial fluid or from a tophaceous deposit. […] In the setting of an acute gout attack, aspiration of joint fluid (by using a needle to draw fluid out of the swollen joint) and examination of the fluid under polarized light can yield the definitive diagnostic finding of needle shaped negatively-birefringent uric acid crystals (yellow when parallel to the axis of polarization). […] Importantly, gout and infection can co-exist in the same joint (they are not mutually exclusive) and consideration should be made for sending joint fluid for culture even in a patient with an established history of gout if they are at risk for infection.

• #1 Gout – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gout/diagnosis-treatment/drc-20372903

  Doctors usually diagnose gout based on your symptoms and the appearance of the affected joint. Tests to help diagnose gout may include: […] Your doctor may use a needle to draw fluid from your affected joint. Urate crystals may be visible when the fluid is examined under a microscope. […] Your doctor may recommend a blood test to measure the levels of uric acid in your blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don’t have unusual levels of uric acid in their blood. […] Joint X-rays can be helpful to rule out other causes of joint inflammation. […] This test uses sound waves to detect urate crystals in joints or in tophi. […] This test combines X-ray images taken from many different angles to visualize urate crystals in joints.

• #1 Gout – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/crystal-induced-arthritides/gout

  Synovial fluid analysis can confirm the diagnosis by identifying needle-shaped, strongly negatively birefringent urate crystals that are free in the fluid or engulfed by phagocytes. […] An elevated serum urate level supports the diagnosis of gout but is neither specific nor sensitive; at least 30% of patients have a normal serum urate level during an acute flare in part due to the uricosuric properties of the proinflammatory cytokine interleukin-6 (IL-6) or because a sudden lowering of the serum urate precipitated the flare. […] The level should be measured on 2 or 3 occasions in patients with newly proven gout to establish a baseline. […] If monotherapy is ineffective or doses (eg, of NSAIDs) are limited by toxicity, colchicine can be combined with NSAIDs or corticosteroids. […] The frequency of acute flares is reduced by taking 0.6 mg of colchicine once or twice a day (maximum 1.2 mg per day depending on tolerance and renal function). […] The goal of urate-lowering therapy is to lower the serum urate level. […] Gout is generally more severe in patients whose initial symptoms appear before age 30 and whose baseline serum uric acid level is 9 mg/dL ( 0.5 mmol/L).

• #1 Gout – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546606/

  Monosodium urate crystal identification remains the gold standard for diagnosing gout. […] This technique can also identify uric acid crystals from tophaceous deposits and joints during the intercritical period. […] The examination usually reveals elevations in the WBC, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) during acute gouty arthritis. […] During acute gouty arthritis, the serum urate level may be high, normal, or low. […] Serum uric acid measurement during an acute attack is of no diagnostic value; it is most useful when checked after the resolution of the flare. […] The most accurate time to assess serum urate level to establish a baseline value is 2 weeks or more after a gout flare has subsided. […] The presence of tophi indicates initiating long-term ULT either during or following the resolution of a gout flare to reverse or prevent joint damage and chronic gouty arthritis.

• #1 gout-diagnosis-management-monitoring-lab-panel | Ulta Lab Tests

  https://www.ultalabtests.com/test/gout-diagnosis-management-and-monitoring-lab-panel?srsltid=AfmBOop_3fZG9oO8YUukM5myhRrVwpWnsthperqdlasQJYRnol6nTFhC

  24-Hour Urinary Uric Acid Test: Assesses the amount of uric acid excreted in urine over a 24-hour period, identifying whether hyperuricemia is due to overproduction or under-excretion of uric acid. Crucial for understanding the metabolic dynamics of uric acid in gout patients, guiding personalized treatment plans. […] Complete Blood Count (CBC): Provides insights into levels of white blood cells, red blood cells, and platelets. Helpful in detecting inflammation or infection during gout flares, aiding in differential diagnosis. […] C-Reactive Protein (CRP): Measures CRP levels, which increase in response to inflammation. Used to assess the severity of inflammation during gout attacks and to monitor how well anti-inflammatory treatments are working. […] Erythrocyte Sedimentation Rate (ESR): Evaluates how quickly red blood cells settle at the bottom of a test tube, a secondary measure of inflammation. Works alongside CRP to provide a comprehensive view of the inflammatory status in gout patients.

• #1 Gout Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/389965-overview

  The diagnosis of gout should not be made on the presence of hyperuricemia alone. […] When a clinical diagnosis of gout is uncertain and crystal identification is not possible, imaging should be used to search for MSU crystal deposition and features of any alternative diagnosis. […] Ultrasound can be more helpful in establishing a diagnosis in patients with suspected gout flares or chronic gouty arthritis by detection of tophi that are not evident on clinical examination, or a double contour (DC) sign at cartilage surfaces, which is highly specific for urate deposits in joints. […] Typical radiographic features include bone erosions with overhanging edges and a sclerotic rim; bone proliferation; joint space narrowing, which occurs late in the disease course; and soft-tissue masses, sometimes calcified, corresponding to soft-tissue tophi.

• #1 Gout: Diagnosis, Treatment, and Steps to Take

  https://www.niams.nih.gov/health-topics/gout/diagnosis-treatment-and-steps-to-take

  Gout tends to be relatively straightforward to diagnose. However, a few conditions can mimic gout. To help diagnose gout, your health care provider may: […] Order a laboratory test to check urate levels in your blood. […] Take a sample of fluid from one of your painful joints, a swollen bursae (fluid-filled sac that cushions the joint), or a tophus to look for urate crystals using a special microscope. […] Order an ultrasound or special CT scan to check for urate crystal buildup in the affected joint as well as to diagnose other conditions that may be causing the symptoms.

• #1 Gout Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/389965-overview

  Rettenbacher et al compared radiography with ultrasonography in diagnosing gout, and radiography suggested gout with a sensitivity of 31% (32/102) and a specificity of 93% (55/59), whereas US suggested gout with a sensitivity of 96% (98/102) and a specificity of 73% (43/59). […] Gruber et al studied 21 patients suspected of having gout in 37 joints by comparing the results of DECT with ultrasonography. They concluded that both imaging techniques had comparable sensitivity for detecting gout, but that DECT had some false-negative findings.

• #1 Gout Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/389965-overview

  Gout is caused by the presence of monosodium urate monohydrate crystals in the joint space and soft tissue that can result in debilitating illness characterized by recurrent episodes of pain and joint inflammation. All patients with gout have hyperuricemia, but gout attacks are not caused by the level of uric acid but by acute changes in the uric acid level. […] Various noninvasive imaging modalities such as radiography, ultrasonography, conventional (single-energy) CT, dual energy CT, and magnetic resonance imaging (MRI), have all been used for the evaluation and diagnosis of gout. Dual-energy CT (DECT) and ultrasonography have been shown to accurately confirm the presence and extent of urate crystals. […] The American College of Rheumatology/European League Against Rheumatism Collaborative Initiative has noted that gout is the most common form of inflammatory arthritis, with a prevalence of 3.9% in the United States, 0.9% in France, 1.4-2.5% in the United Kingdom, 1.4% in Germany, and 3.2% (European ancestry) – 6.1% (Maori ancestry) in New Zealand.

• #1 Diagnosis and Management of Gout: Current State of the Evidence | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/gout/clinician

  Two recently developed clinical algorithms to diagnose gout—the Diagnostic Rule and the Clinical Gout Diagnosis—demonstrated sensitivities of 88 percent and 97 percent, respectively, and specificities of 75 percent and 96 percent, respectively, when compared with MSU crystal analysis. […] The strength of evidence (SOE) supporting the use of these clinical algorithms was moderate; these algorithms have not yet been validated in primary care, emergency care, and urgent care settings. […] The strength of evidence regarding the use of DECT (sensitivity: 85-100%; specificity: 83-92%) or of ultrasound (sensitivity: 74%; specificity: 88%) to diagnose gout was low. […] The two systematic reviews summarized here assessed the accuracy of tests to diagnose gout and also examined the evidence regarding the treatment of gout in the primary care setting.

• #1 Gout Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/gout/diagnosis.html

  To diagnose gout, your doctor may do: […] A joint fluid analysis to look for uric acid crystals. This is the only certain way to diagnose gout. […] A medical history and physical exam. […] A test to measure levels of uric acid in blood. This may be done if your doctor can’t safely get fluid from the affected joint. […] A test to measure levels of uric acid in urine. […] Imaging tests, like ultrasound and computed tomography. […] While X-rays of hands and feet are sometimes useful in the late stages of gout, X-rays aren’t usually helpful in the early diagnosis. Pain often causes people to seek medical care before any long-term changes can be seen on an X-ray. But X-rays may help to rule out other causes of arthritis.

• #1 Gout

  https://www.nhs.uk/conditions/gout/

  Gout is a type of arthritis that causes sudden, severe joint pain. The main symptoms of gout are sudden severe pain in a joint usually your big toe, but it can be in other joints in your feet, ankles, hands, wrists, elbows or knees. Hot, swollen, red skin over the affected joint redness may be harder to see on black or brown skin. An attack of gout usually lasts 1 to 2 weeks if left untreated. If you do not get treatment, future attacks may last even longer. Leaving gout untreated may cause lasting damage to joints. The GP may ask about your diet and if you drink alcohol if you have symptoms of gout. They may also do a test to measure how much uric acid is in your blood. Uric acid is a chemical that can lead to crystals forming around your joints which cause pain. If the test is still unclear, a GP may refer you to see a specialist (rheumatologist) and arrange further tests. This could include taking a sample of fluid from inside the affected joint, using a thin needle. If this test cannot be done or the diagnosis is still unclear, then a scan will be arranged. Gout can come back every few months or it may be years. It can come back more often if it’s not treated. If you have frequent attacks or high levels of uric acid in your blood, you may need to take uric acid-lowering medicine. It’s important to take uric acid-lowering medicine regularly, even when you no longer have symptoms.

• #1 The Diagnosis and Treatment of Gout

  https://www.uspharmacist.com/article/the-diagnosis-and-treatment-of-gout

  They also determined that computed tomography provides excellent definition of tophi and bone erosion, and three-dimensional computed tomography assessment of tophus volume is a promising outcome measure in gout. […] Finally, they state that magnetic resonance imaging is also a reliable method for assessment of tophus size in gout and has an important role in detection of complications of the disease in clinical practice.

• #1 Diagnosis, Treatment, and Prevention of Gout | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1215/p831.html

  Gout is typically diagnosed using clinical criteria from the American College of Rheumatology. Diagnosis may be confirmed by identification of monosodium urate crystals in synovial fluid of the affected joint. […] Gout is typically diagnosed clinically based on the rapid development of monoarticular arthritis marked by swelling and redness usually involving the first metatarsophalangeal joint. The American College of Rheumatology criteria are the most widely used for diagnosis of gout. […] Microscopy of joint fluid is used less often, primarily in equivocal cases. In these situations, the diagnosis is established by aspiration of a joint or tophus and identification of needle-shaped monosodium urate crystals, preferably intracellular, with bright, negative birefringence on compensated polarized light microscopy.

• #1 Gout – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546606/

  Gout is one of the most common causes of chronic inflammatory arthritis in the United States, characterized by monosodium urate (MSU) monohydrate crystals deposition in the tissues. […] This activity reviews the evaluation and management of gout and highlights the role of interprofessional team members in collaborating to provide well-coordinated care and enhance patient outcomes. […] Identify the clinical and biochemical markers of gout, including hyperuricemia and monosodium urate crystals, for accurate diagnosis. […] A definitive diagnosis of gout is accepted in the presence of monosodium urate monohydrate crystals in the joint fluid or the identification of tophus. […] The 2015 ACR/EULAR criteria have a sensitivity of 92% and specificity of 89%, surpassing the accuracy of all previous definitions and ensuring a more precise and reliable diagnosis of gout in epidemiological studies.

• #1 Gout: clinical features and diagnosis – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/gout-clinical-features-and-diagnosis

  Another tool used for the diagnosis of gout is the Janssens clinical prediction rule. It sets out seven criteria and attributes a score for each criterion met. If a patient scores <4 a diagnosis of gout is highly unlikely. If a score of >8 is achieved then it is more than 80% likely that gout is an accurate diagnosis. […] Patients who score 8 or more using the Janssens clinical prediction rule should be started on empirical treatment pending laboratory results (such as SUA level).

• #1 Diagnosis, Treatment, and Prevention of Gout | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1215/p831.html

  The differential diagnosis for acute monoarticular joint swelling includes pseudogout, infection, and trauma. Pseudogout, or calcium pyrophosphate deposition disease, can mimic gout in clinical appearance and may respond to nonsteroidal anti-inflammatory drugs (NSAIDs). Findings of calcium pyrophosphate crystals and normal serum uric acid levels on joint fluid analysis can differentiate pseudogout from gout. Septic arthritis may present without a fever or elevated white blood cell count; arthrocentesis is required to distinguish this condition from acute gout. Gout and septic arthritis can occur concomitantly, but this is rare. […] To achieve rapid and complete resolution of symptoms, treatment of acute gout should commence within 24 hours of symptom onset. Oral corticosteroids, intravenous corticosteroids, NSAIDs, and colchicine are equally effective in treating acute flares of gout.

• #1 HealthtalkTests and diagnosis of gout | Real People. Real life experiences. | Healthtalk

  https://healthtalk.org/experiences/gout/tests-and-diagnosis-gout/

  Once gout is diagnosed it’s important to check for other conditions that are linked with gout, such as diabetes, high cholesterol, or kidney disease. […] Examination of a fluid sample also allows doctors to distinguish between other similar conditions, such as pseudogout (caused by calcium pyrophosphate crystals) and septic arthritis (infection in the joint). If uric acid crystals can be seen when this sample is examined under a microscope, then the diagnosis of gout is confirmed. […] X-rays of joints can show joint damage that has occurred from untreated or poorly controlled gout, but they are not often useful for confirming the diagnosis because they’re usually normal in the early years of having gout. Blood tests to measure levels of uric acid can support a diagnosis of gout, but cannot confirm it. This is because it is possible for people with gout to have normal levels of uric acid, especially during an attack. In addition, most people who have raised levels of uric acid will not develop gout.

• #1 Recommendations | Gout: diagnosis and management | Guidance | NICE

  https://www.nice.org.uk/guidance/ng219/chapter/Recommendations

  Suspect gout in people presenting with any of the following: […] Measure the serum urate level in people with symptoms and signs of gout to confirm the clinical diagnosis (serum urate level of 360 micromol/litre [6 mg/dl] or more). […] Consider joint aspiration and microscopy of synovial fluid if a diagnosis of gout remains uncertain or unconfirmed. […] If joint aspiration cannot be carried out or the diagnosis of gout remains uncertain, consider imaging the affected joints with X-ray, ultrasound or dual-energy CT. […] Provide tailored information to people with gout and their family members or carers (as appropriate) at the time of diagnosis and during subsequent follow-up appointments. […] Offer ULT, using a treat-to-target strategy, to people with gout who have: multiple or troublesome flares, CKD stages 3 to 5, diuretic therapy, tophi, chronic gouty arthritis.

• #1 Gout – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897

  Gout causes intense pain and swelling around one or more joints. Gout most commonly affects the joint at the base of the big toe. […] If you experience sudden, intense pain in a joint, call your doctor. Gout that goes untreated can lead to worsening pain and joint damage. Seek medical care immediately if you have a fever and a joint is hot and inflamed, which can be a sign of infection. […] Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines substances that are found naturally in your body. […] Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, obesity, metabolic syndrome, and heart and kidney diseases. […] Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.

• #1 Gout/Gouty Arthritis In Depth: Risk Factors, Treatment | HSS

  https://www.hss.edu/conditions_gout-risk-factors-diagnosis-treatment.asp

  Gout is best understood by seeing it as having four phases or stages. […] Gout is clearly associated with a buildup of uric acid. […] The most common cause of gout (about 90% of cases) is the inability to excrete enough uric acid in the urine. […] In a clear-cut case, a primary care physician can make the diagnosis of gout with a high level of confidence. […] Ideally, the diagnosis is made by identifying uric acid crystals in joint fluid or in a mass of uric acid (tophus). […] A set of criteria has been established to help make the diagnosis of gout in this setting. […] The diagnosis of gout is made in the presence of 6 of the 10 criteria listed in Table 1. […] When the diagnosis of gout is made, the individual must be evaluated for the complications of gout. […] It is important that damage to bone from gout be diagnosed, since documented damage is a clear indication for long-term therapy. […] The red and hot joints, coupled with rapid acceleration of joint pain, strongly suggest gout, and identifying tophi, if present, help further. […] Special effort should be made to distinguish gout from the other crystal-induced types of arthritis.

• #1 Get Gout Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/gout-treatment

  Gout Diagnosis at Cleveland Clinic […] Gout typically affects your big toe, but it can also affect other joint areas like your ankle, knee, elbow, hand and wrist. Our providers will talk with you about your symptoms and perform a physical exam. Theyll also do testing to confirm the diagnosis so they can move forward in crafting a personalized treatment plan. […] Blood tests for gout […] Specialists draw a blood sample to measure the amount of uric acid in your blood. A high uric acid level doesnt mean youll develop gout, but it may put you at higher risk for the condition. Our healthcare providers rely on more than just this blood test to diagnose gout. […] Imaging tests for gout […] Our imaging specialists use advanced techniques to see detailed views of uric acid crystals within your joints and in the surrounding tissue. These crystals cause joint swelling and inflammation. We may use a dual energy CT-scan (DECT). This specialized CT-scan uses two different energy types to see crystal formations. We may also use:

• #1 Recommendations | Gout: diagnosis and management | Guidance | NICE

  https://www.nice.org.uk/guidance/ng219/chapter/Recommendations

  Start ULT at least 2 to 4 weeks after a gout flare has settled. […] Aim for a target serum urate level below 360 micromol/litre (6 mg/dl). […] Offer either allopurinol or febuxostat as first-line treatment when starting treat-to-target ULT. […] Consider referring a person with gout to a rheumatology service if: the diagnosis of gout is uncertain, treatment is contraindicated, not tolerated or ineffective.

• #1 Testing for Gout | Arthritis Foundation

  https://www.arthritis.org/diseases/more-about/testing-for-gout

  Ultrasound, or sonography, uses sound waves to create pictures of structures inside the body. It may be used to detect urate crystals in the joints or deposits of uric acid crystals that form hard, visible lumps in or near the joints, called tophi. […] A test that combines X-ray images from many different angles, DECT may be used to see uric acid crystals in the joints. […] Because treatment for gout is targeted at lowering levels of uric acid in the blood to a target of 6 milligrams per deciliter (6 mg/dL) or lower, blood tests to check uric acid levels are performed periodically to monitor the effectiveness of treatment. […] Your doctor may order check for high levels of uric acid in your urine, which could indicate a risk for kidney stones. […] Your doctor may order one of the following imaging tests to check for joint damage.

• #1 Diagnosis of Gout | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/gout/research-protocol-2014

  Gout is a form of inflammatory arthritis characterized by acute intermittent episodes of synovitis presenting with joint swelling and pain (referred to as acute gouty arthritis) that may progress to a chronic intermittent condition, which may progress further to development of tophi (solid deposits of monosodium urate [MSU] crystals in joints, cartilage, and bones), a condition called chronic tophaceous gout. […] Definitive diagnosis of gout requires laboratory confirmation of joint/synovial fluid MSU in the setting of an acute inflammatory arthritis. […] In 2006, the European League Against Rheumatism (EULAR) issued guidelines for diagnosis of gout based on a systematic review of the evidence and a modified Delphi approach: the factors with the strongest evidence to confirm the diagnosis of gout included the presence of needle-like MSU crystals, showing strong negative birefringence by polarized microscopy in synovial fluid; whereas a clinical diagnosis, hyperuricemia, or radiological evidence alone were not considered definitive, they did document high likelihood of gout.

• #1 Gout: Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/4755-gout

  There’s no cure for gout. You’ll experience fewer attacks once you work with a healthcare provider to find treatments that manage your symptoms and lower your uric acid levels. […] Visit a healthcare provider if you experience sudden intense pain in any of your joints, especially if your joint is also swollen and your skin is red or discolored. Gout shares many symptoms with infections that need to be treated right away. […] Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals that collect in your joints, causing pain, swelling and other symptoms. Talk to your healthcare provider about medication and changes in your diet that can help you manage your symptoms and reduce how often you experience attacks in the future.

• #2 Gout: Clinical manifestations and diagnosis – UpToDate

  https://www.uptodate.com/contents/gout-clinical-manifestations-and-diagnosis

  Gout is caused by tissue deposition of monosodium urate (MSU) crystals and can cause a variety of clinical manifestations, including the following: […] Providers typically diagnose gout based on a combination of clinical features, laboratory testing (eg, serum urate, synovial fluid MSU crystals), and, in some cases, imaging. […] Visualization of MSU crystals in the synovial fluid of a symptomatic joint or bursa provides a more specific means to diagnose gout, but it requires involvement of a joint or bursae that is amenable to aspiration (ie, an intermediate- to large-sized joint) and access to an experienced provider to obtain and analyze fluid.

• #2 Diagnosis, Treatment, and Prevention of Gout | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1215/p831.html

  Gout is typically diagnosed using clinical criteria from the American College of Rheumatology. Diagnosis may be confirmed by identification of monosodium urate crystals in synovial fluid of the affected joint. […] Gout is typically diagnosed clinically based on the rapid development of monoarticular arthritis marked by swelling and redness usually involving the first metatarsophalangeal joint. The American College of Rheumatology criteria are the most widely used for diagnosis of gout. […] Microscopy of joint fluid is used less often, primarily in equivocal cases. In these situations, the diagnosis is established by aspiration of a joint or tophus and identification of needle-shaped monosodium urate crystals, preferably intracellular, with bright, negative birefringence on compensated polarized light microscopy.

• #2 Gout – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546606/

  Gout is one of the most common causes of chronic inflammatory arthritis in the United States, characterized by monosodium urate (MSU) monohydrate crystals deposition in the tissues. […] This activity reviews the evaluation and management of gout and highlights the role of interprofessional team members in collaborating to provide well-coordinated care and enhance patient outcomes. […] Identify the clinical and biochemical markers of gout, including hyperuricemia and monosodium urate crystals, for accurate diagnosis. […] A definitive diagnosis of gout is accepted in the presence of monosodium urate monohydrate crystals in the joint fluid or the identification of tophus. […] The 2015 ACR/EULAR criteria have a sensitivity of 92% and specificity of 89%, surpassing the accuracy of all previous definitions and ensuring a more precise and reliable diagnosis of gout in epidemiological studies.

• #2 Investigations and diagnosis in gout – Primary Care Notebook

  https://primarycarenotebook.com/pages/general-information/gout/investigations-and-diagnosis-in-gout

  since gout and sepsis may coexist with each other, it is always best to perform a gram staining and a culture of the synovial fluid even after MSU crystals have been identified in our diagnosis, to rule out septic arthritis […] assessment of renal UA excretion should, however, be considered in those with young-onset gout (aged 25 years) or in patients with a family history of young-onset gout […] a high incidence of renal stones are present in people with gout hence, those with stones should have a lithogenic workup […] radiographs are not used to confirm the diagnosis of early or acute gout and should be done only in the case of suspecting a fracture […] it is highly important to assess the risk factors for gout, which includes: features of metabolic syndrome (hyperglycemia, hyperlipidemia, hypertension and obesity), chronic kidney disease (CKD), medications (diuretics), family history, and lifestyle.

• #2 Gout Symptoms and Diagnosis | Johns Hopkins Arthritis Center

  https://www.hopkinsarthritis.org/arthritis-info/gout/clinical-presentation-of-gout/

  Tophaceous material expressed and examined under polarize microscopy as well to confirm a diagnosis of chronic tophaceous gout. […] Serum uric acid concentrations may be supportive of a diagnosis of gout, but alone the presence of hyperuricemia or normal uric acid concentrations do not confirm or rule out the diagnosis of gout as frequently uric acid levels may be normal during an acute gout attack.

• #2 Gout: Diagnosis and management – Medical Independent

  https://www.medicalindependent.ie/societies/isr/gout-diagnosis-and-management/

  Gout is a chronic inflammatory process that requires lifelong treatment and is associated with an increased burden of cardiovascular co-morbidities and higher mortality. […] A diagnosis of tophaceous gout was made. Of note, serum uric acid levels were elevated 639umol/L (177-465umol/L). […] This case illustrates the difficulty of diagnosing and managing gout. […] The gold standard of diagnosis is the microscopic analysis of synovial fluid or tophi. MSU crystals are needle shaped and negatively birefringent under polarised light. […] Serum urate concentrations can be normal in a flare due to increased renal excretion, and thus can represent a negative acute phase reactant. […] Inflammatory markers, such as C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR), will be elevated during an acute flare, however, these are non-specific findings.

• #2 Investigations and diagnosis in gout – Primary Care Notebook

  https://primarycarenotebook.com/pages/general-information/gout/investigations-and-diagnosis-in-gout

  in gout serum urate levels may be normal during an acute attack and thus the optimal time for measurement is about two weeks after a flare resolves (2) […] a clinical diagnosis alone is a reasonable alternative in patients with typical presentations of gout but a definite diagnosis of gout is made when of MSU crystals are demonstrated in synovial fluid or tophus aspirates constitutes […] serum urate acid (SUA) levels do not confirm or exclude gout (although this is the most important risk factor for gout), since many people with hyperuricemia do not develop gout, and SUA levels may be normal during acute attacks […] a routine search for MSU crystals is always better to look for in synovial fluid samples that were obtained from the undiagnosed inflamed joints […] in case of a doubtful diagnosis, the best way to make a definite diagnosis is by identification of MSU crystals from asymptomatic joints, during the intercritical period

• #2 Gout and kidney disease: Symptoms, causes & prevention | American Kidney Fund

  https://www.kidneyfund.org/living-kidney-disease/health-problems-caused-kidney-disease/gout/tests-gout

  Doctors use blood and urine tests to check uric acid levels, which can help diagnose gout. Normal levels are 3.5-7.2 mg/dL in blood and 250-750 mg in urine (collected over 24 hours). […] Neither the uric acid blood nor the urine test should be used alone when diagnosing gout. Doctors use the results together with other tests to confirm.

• #2 Gout Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/389965-overview

  Gout is caused by the presence of monosodium urate monohydrate crystals in the joint space and soft tissue that can result in debilitating illness characterized by recurrent episodes of pain and joint inflammation. All patients with gout have hyperuricemia, but gout attacks are not caused by the level of uric acid but by acute changes in the uric acid level. […] Various noninvasive imaging modalities such as radiography, ultrasonography, conventional (single-energy) CT, dual energy CT, and magnetic resonance imaging (MRI), have all been used for the evaluation and diagnosis of gout. Dual-energy CT (DECT) and ultrasonography have been shown to accurately confirm the presence and extent of urate crystals. […] The American College of Rheumatology/European League Against Rheumatism Collaborative Initiative has noted that gout is the most common form of inflammatory arthritis, with a prevalence of 3.9% in the United States, 0.9% in France, 1.4-2.5% in the United Kingdom, 1.4% in Germany, and 3.2% (European ancestry) – 6.1% (Maori ancestry) in New Zealand.

• #2 Testing for Gout | Arthritis Foundation

  https://www.arthritis.org/diseases/more-about/testing-for-gout

  Ultrasound, or sonography, uses sound waves to create pictures of structures inside the body. It may be used to detect urate crystals in the joints or deposits of uric acid crystals that form hard, visible lumps in or near the joints, called tophi. […] A test that combines X-ray images from many different angles, DECT may be used to see uric acid crystals in the joints. […] Because treatment for gout is targeted at lowering levels of uric acid in the blood to a target of 6 milligrams per deciliter (6 mg/dL) or lower, blood tests to check uric acid levels are performed periodically to monitor the effectiveness of treatment. […] Your doctor may order check for high levels of uric acid in your urine, which could indicate a risk for kidney stones. […] Your doctor may order one of the following imaging tests to check for joint damage.

• #2 Gout Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/389965-overview

  The diagnosis of gout should not be made on the presence of hyperuricemia alone. […] When a clinical diagnosis of gout is uncertain and crystal identification is not possible, imaging should be used to search for MSU crystal deposition and features of any alternative diagnosis. […] Ultrasound can be more helpful in establishing a diagnosis in patients with suspected gout flares or chronic gouty arthritis by detection of tophi that are not evident on clinical examination, or a double contour (DC) sign at cartilage surfaces, which is highly specific for urate deposits in joints. […] Typical radiographic features include bone erosions with overhanging edges and a sclerotic rim; bone proliferation; joint space narrowing, which occurs late in the disease course; and soft-tissue masses, sometimes calcified, corresponding to soft-tissue tophi.

• #2

  https://www.parkwayeast.com.sg/conditions-diseases/gout/diagnosis-treatment

  Diagnostic tests for gout include: […] Blood tests to see if there is a high level of uric acid and creatinine in the blood. However blood tests may not be conclusive, as some individuals with high uric acid levels do not experience gout, while others may experience gout even without high levels of uric acid. […] Ultrasound scans of the musculoskeletal structure to reveal urate crystals deposited in the joints. […] Dual-energy computerised tomography (CT) scans to create high-quality images that can detect urate crystals in a joint, even when it is not inflamed.

• #2 Gout Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/gout/diagnosis.html

  To diagnose gout, your doctor may do: […] A joint fluid analysis to look for uric acid crystals. This is the only certain way to diagnose gout. […] A medical history and physical exam. […] A test to measure levels of uric acid in blood. This may be done if your doctor can’t safely get fluid from the affected joint. […] A test to measure levels of uric acid in urine. […] Imaging tests, like ultrasound and computed tomography. […] While X-rays of hands and feet are sometimes useful in the late stages of gout, X-rays aren’t usually helpful in the early diagnosis. Pain often causes people to seek medical care before any long-term changes can be seen on an X-ray. But X-rays may help to rule out other causes of arthritis.

• #2 Gout: clinical features and diagnosis – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/gout-clinical-features-and-diagnosis

  Gout: clinical features and diagnosis […] The definitive diagnostic test for gout is the identification of urate crystals in synovial fluid aspirated from an affected joint. […] The European League Against Rheumatism (EULAR) has set out diagnostic criteria for gout, based on clinical findings. Rapid development of severe pain, swelling and tenderness that reaches a peak in six to 12 hours, in combination with overlying erythema, is likely to indicate crystal inflammation. […] According to the American College of Rheumatology, presence of six or more of the following clinical features indicates a diagnosis of gout: More than one attack of acute arthritis; Maximum inflammation developing within 24 hours; Attack of monoarthritis; Erythema over the affected joints; Painful or swollen first metatarsophalangeal joint; Unilateral attack on tarsal joint; Tophus (suspected or proven); Hyperuricaemia; Asymmetric swelling within a joint witnessed via radiography; Subcortical cysts without erosions visible on a radiograph.

• #2 Gout | Choose the Right Test

  https://arupconsult.com/content/hyperuricemia

  Gout is a type of inflammatory arthritis caused by the deposition of monosodium urate (MSU) crystals in tissues and joints as a result of persistent hyperuricemia. […] Accurate gout diagnosis is important to ensure proper treatment and medical management; it is particularly important to differentiate gout from conditions such as rheumatoid arthritis and septic arthritis because treatment of these conditions differs. […] Detection of MSU crystals in synovial fluid aspirate remains the standard for definitive diagnosis; however, this technique is painful and often technically difficult. […] The American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) have developed a scoring system based on clinical and laboratory findings to aid in the diagnosis of gout.

• #2 Gout – Wikipedia

  https://en.wikipedia.org/wiki/Gout

  Gout may be diagnosed and treated without further investigations in someone with hyperuricemia and the classic acute arthritis of the base of the great toe (known as podagra). […] Synovial fluid analysis should be done if the diagnosis is in doubt. […] A definitive diagnosis of gout is based upon the identification of monosodium urate crystals in synovial fluid or a tophus. […] All synovial fluid samples obtained from undiagnosed inflamed joints by arthrocentesis should be examined for these crystals. […] Hyperuricemia is a classic feature of gout, but nearly half of the time gout occurs without hyperuricemia and most people with raised uric acid levels never develop gout. […] Thus, the diagnostic utility of measuring uric acid levels is limited. […] The most important differential diagnosis in gout is septic arthritis. […] This should be considered in those with signs of infection or those who do not improve with treatment.

• #2 Gout and kidney disease: Symptoms, causes & prevention | American Kidney Fund

  https://www.kidneyfund.org/living-kidney-disease/health-problems-caused-kidney-disease/gout/tests-gout

  Gout is a form of arthritis caused by crystals that form in the joins from too much uric acid in your blood. Kidney disease can increase your risk for gout, and having gout may affect your kidneys. […] If you have gout, talk to your doctor about preventing kidney disease. […] One in 10 people with chronic kidney disease (CKD) have gout, and about 1 in 4 people with gout have CKD. When you have CKD, your kidneys do not work as well as they should to filter waste, such as uric acid, out of your body. Uric acid can build up and form urate crystals as your blood is filtered through your kidneys. […] If you think you might have gout, it’s important to get diagnosed by a doctor so that you can get the treatment you need. The tests can include: […] The synovial fluid test is the most accurate test for gout. Synovial fluid is a liquid found in your joints. This test examines the fluid for urate crystals that indicate that you have gout.

• #2 Gout: Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/4755-gout

  Gout is a form of inflammatory arthritis that causes pain and swelling in your joints. Gout happens when there’s a buildup of uric acid in your body. […] A healthcare provider will diagnose gout with a physical exam. They’ll ask you about your symptoms and examine your affected joints. […] Your healthcare provider might use a few imaging tests to take pictures of your affected joints. These tests can also show if gout has caused any changes in your joints. […] Other common tests to diagnose gout include blood tests to measure the uric acid in your blood. […] Treating gout is usually a combination of managing your symptoms during a flare and reducing how often you consume high-purine foods and drinks. […] Your healthcare provider may suggest you follow a low-purine diet. A low-purine diet encourages you to consume fewer foods and drinks with high purine content.

• #2 Gout

  https://www.nhs.uk/conditions/gout/

  Gout is a type of arthritis that causes sudden, severe joint pain. The main symptoms of gout are sudden severe pain in a joint usually your big toe, but it can be in other joints in your feet, ankles, hands, wrists, elbows or knees. Hot, swollen, red skin over the affected joint redness may be harder to see on black or brown skin. An attack of gout usually lasts 1 to 2 weeks if left untreated. If you do not get treatment, future attacks may last even longer. Leaving gout untreated may cause lasting damage to joints. The GP may ask about your diet and if you drink alcohol if you have symptoms of gout. They may also do a test to measure how much uric acid is in your blood. Uric acid is a chemical that can lead to crystals forming around your joints which cause pain. If the test is still unclear, a GP may refer you to see a specialist (rheumatologist) and arrange further tests. This could include taking a sample of fluid from inside the affected joint, using a thin needle. If this test cannot be done or the diagnosis is still unclear, then a scan will be arranged. Gout can come back every few months or it may be years. It can come back more often if it’s not treated. If you have frequent attacks or high levels of uric acid in your blood, you may need to take uric acid-lowering medicine. It’s important to take uric acid-lowering medicine regularly, even when you no longer have symptoms.

• #2 Rare and Unusual Clinical Presentations of Gout – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/features/rare-unusual-clinical-presentations-gout/

  Gout is a type of inflammatory arthritis characterized by the deposition of monosodium urate crystals and the formation of tophi in tissues, typically in or around the joints. Gout occurs more commonly in men compared with women and usually presents with sudden onset of severe pain, redness, and swelling of a single joint, most often in the feet, ankle, or knee. For example, the initial presentation of gout involves the first metatarsophalangeal joint in an estimated 56% to 78% of patients. […] Dr Fitzpatrick advised that providers keep gout on the differential for any patients who present with inflammatory joint pain, but to remain aware that the disease can present in unusual ways. […] The gold standard to diagnose gout is joint aspiration. The joint fluid will show needle shaped crystals with negative birefringence when viewed under a microscope fitted with polarized light. […] Dual energy computed tomography can show monosodium urate crystals in the joint or around the joints and may be an effective way of diagnosing gout involving unusual locations, such as the spine.

• #2 Recommendations | Gout: diagnosis and management | Guidance | NICE

  https://www.nice.org.uk/guidance/ng219/chapter/Recommendations

  Suspect gout in people presenting with any of the following: […] Measure the serum urate level in people with symptoms and signs of gout to confirm the clinical diagnosis (serum urate level of 360 micromol/litre [6 mg/dl] or more). […] Consider joint aspiration and microscopy of synovial fluid if a diagnosis of gout remains uncertain or unconfirmed. […] If joint aspiration cannot be carried out or the diagnosis of gout remains uncertain, consider imaging the affected joints with X-ray, ultrasound or dual-energy CT. […] Provide tailored information to people with gout and their family members or carers (as appropriate) at the time of diagnosis and during subsequent follow-up appointments. […] Offer ULT, using a treat-to-target strategy, to people with gout who have: multiple or troublesome flares, CKD stages 3 to 5, diuretic therapy, tophi, chronic gouty arthritis.

• #2 Diagnosis of Gout | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/gout/research-protocol-2014

  The majority of individuals with gout are initially seen, diagnosed, and treated in primary and urgent care settings. Therefore primary care physicians (PCPs) and emergency medicine physicians are well-positioned to diagnose early-stage gout and implement management strategies. […] However, use of the gold standard synovial fluid analysis for diagnosis of gout is difficult and seldom performed in the primary care setting. […] Instead, PCPs and emergency medicine physicians may tend to rely on a combination of clinical signs and symptoms to diagnose an acute episode of gout. […] Therefore a systematic review delineating the accuracy of tests used to diagnose gout, including physical findings, serum UA, ultrasound (US), plain radiography, and dual-energy computed tomography (DECT), compared with synovial fluid UA can be used to inform clinical decision-making for patients and providers and improve the quality of care for patients with gout in the primary and acute care setting.

• #2 Gout | Gouty Arthritis | MedlinePlus

  https://medlineplus.gov/gout.html

  Gout is a common type of inflammatory arthritis. It causes pain, swelling, and redness in one or more joints. […] To find out if you have gout, your health care provider: […] May order various tests, such as: […] A test of a sample of fluid from one of your painful joints. The fluid is examined under a microscope and is checked for uric acid crystals. […] A uric acid blood or urine test. […] An ultrasound or special CT scan to look for uric acid crystal buildup in the affected joint and check for other conditions that may be causing the symptoms. […] With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis.

• #3 Gout- diagnosis and treatment | Comprehensive Rheumatology

  https://comprehensiverheumatology.com/index.html@p=242.html

  Gout is suspected when someone has acute onset of a red, hot, swollen and tender joint. If the affected joint is a great toe, the suspicion is even stronger. Blood tests may show an elevated uric acid level which would be expected with gout. Xrays may be normal or may show evidence of joint destruction from tophi. […] The gold standard of gout diagnosis is presence of monosodium urate crystals in the fluid from a joint. These crystals are needle-shaped structures that look either blue or red- depending on their orientation- under a polarized microscope. To find these crystals, a sample of the fluid is removed from the joint with a needle and looked at under the microscope.

• #3 Gout: Symptoms, Diagnosis, and Treatment | Arthritis Foundation

  https://www.arthritis.org/diseases/gout

  Gout is the most common type of inflammatory arthritis. It causes sudden and intense attacks of joint pain, often in the big toe and at night. […] Your medical history, a physical exam and tests can help diagnose gout. Your doctor will also want to rule out other reasons for your joint pain and inflammation such as an infection, injury or other type of arthritis. Tests you might have include: […] Joint fluid analysis. This is best way to diagnose gout. Your doctor withdraws fluid from the painful joint(s) and examines it under a microscope for uric acid crystals. […] Blood test to check uric acid levels. However, many people who have high blood uric acid never develop gout, and some people with gout have normal uric acid levels. […] Imaging tests, such as X-rays, ultrasound, magnetic resonance imaging and dual-energy computerized tomography, which helps visualize uric acid crystals in joints.

• #3 Criteria for Gout Diagnosis? | The Journal of Rheumatology

  https://www.jrheum.org/content/40/4/356

  Diagnosis is the proper classification of an individual patient. […] A proper approach to gout diagnosis implies that, if possible, (1) all patients presenting with the disease have to be properly diagnosed, and (2) in all cases the diagnosis must be correct, so gout does not go undetected and is not misclassified. […] MSU crystal identification provides an etiological proof of gout and is considered the gold standard for diagnosis. […] A clinically based diagnosis should be designated provisional or not-crystal-proven as a reminder of its possible uncertainties. […] Finally, unequivocal gout diagnosis by crystal identification is an elegant approach taught in medical schools and widely known by physicians.

• #3 Recommendations | Gout: diagnosis and management | Guidance | NICE

  https://www.nice.org.uk/guidance/ng219/chapter/Recommendations

  Suspect gout in people presenting with any of the following: […] Measure the serum urate level in people with symptoms and signs of gout to confirm the clinical diagnosis (serum urate level of 360 micromol/litre [6 mg/dl] or more). […] Consider joint aspiration and microscopy of synovial fluid if a diagnosis of gout remains uncertain or unconfirmed. […] If joint aspiration cannot be carried out or the diagnosis of gout remains uncertain, consider imaging the affected joints with X-ray, ultrasound or dual-energy CT. […] Provide tailored information to people with gout and their family members or carers (as appropriate) at the time of diagnosis and during subsequent follow-up appointments. […] Offer ULT, using a treat-to-target strategy, to people with gout who have: multiple or troublesome flares, CKD stages 3 to 5, diuretic therapy, tophi, chronic gouty arthritis.

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