How is gout diagnosed?

How does your doctor know that you have gout?

Your doctor is likely to ask you about any previous attacks of gouty arthritis, and which joints are (and have been) involved.

Acute attacks of gout become less frequent as the disease progresses

Arthritis in the big toe

The initial attack of gout affects the first joint of the big toe in 70% of people, and this joint is affected in 90% of cases at some time in their "gout career."

Gout comes on very quickly and this can help your doctor spot that you have it. Inflammation usually reaches maximum intensity within 24 hours.

Your doctor will also ask about your recent diet intake and about any recent medications you might have been taking.

The following topics are often important:

• Alcohol ingestion
• Dietary intake of meat and seafood
• Use of drugs that can raise plasma urate levels such as cancer drugs and diuretics or water tablets.

Your doctor will also consider other conditions that can increase your risk of developing gout (although remember that most gout cases have no underlying reason at all)!

The doctor's examination of a possible gout patient

Your doctor will look for evidence of:

Arthritis (swelling, redness, warmth, pain on passive movement)

The big toe is the site most frequently affected in gout.

Other joints affected are in the instep, heel, ankle, knee, finger, wrist, and elbow (listed in order of decreasing frequency)
Leg joints are affected more frequently than arm joints.

Tophi (firm, white, translucent nodules) can be seen in the skin or around joints - often on the earlobe. It usually takes at least 10 years after the first attack of gout for tophi to develop and not all those with gout will develop them.

Tophi are most commonly found on fingers, toes, the outer side of forearms, behind the elbow, over the Achilles tendons and in the helix of the ears; but they can occur anywhere in the body.

The pattern of tophi and joint involvement is characteristically asymmetric.

Gout Blood Tests

Your doctor will probably take a blood sample and test for the blood urate level. But remember that gout can occur without a high blood urate level - and many people with a high blood urate level never get gout. Even more confusing is the fact that the blood urate level can actually fall a bit during an acute attack.

Some doctors might choose to take a sample of fluid from inside a joint and look at the fluid under a microscope. If you do this you can see crystals. Taking this kind of joint fluid sample also allows your doctor to rule out infection as the cause of your joint pain.

X-ray can also be helpful in gout pain patients.

Your doctor might also check for the Erythrocyte sedimentation rate or ESR test. A raised ESR test makes joint infection more likely to be the diagnosis.

The American College of Rheumatologists drew up helpful criteria to help doctors diagnose gout accurately.

Six or more of the following criteria must be met before a formal diagnosis of gout can be made:

• More than one attack of acute arthritis
• Maximal inflammation developing within 1 day
• Only one joint involved at a time (90% of initial gout attacks involve only one joint)
• Redness over affected joint
• One-foot attack on the big toe or foot joints.
• Tophi (proven or suspected
• High blood urate level
• Typical gout x-ray changes
• No organisms found on culture of synovial fluid (and thus no evidence of infection)

An acute attack of gout can also be accompanied by raised temperature, and a high white blood cell count, platelet count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level

If it's not gout then what else might it be?

•  Septic arthritis or joint infection

• Septic arthritis must be considered in any acute hot joint. Septic arthritis is important to diagnose, as late recognition can be fatal.

• Osteoarthritis

• Psoriatic arthritis

• Reactive arthritis

• Rheumatoid arthritis or one of a number of other rheumatoid arthritis like conditions

The Complications of Gout

Tophi
Tophi may create a physical hindrance, become inflamed, exude cheesy white material, or develop secondary infection.

Urinary stones
The annual incidence of urinary stones in people suffering from gout is about one in a hundred.

Kidney inflammation

Kidney inflammation or nephritis is a rare complication of gout but can run in families