How is gout diagnosed?
Before a consultation with the doctor, there are things a person can do to alleviate gout symptoms:
- Keep the affected joint elevated
- Use cold compresses / ice packs on the affected joint
- Take a recommended dose of anti-inflammatory medication, such as ibuprofen or aspirin
- Drink plenty of water (this will help flush out the urinary system and potentially clear the urinary tract of any uric acid crystals). It is best not to consume any sweetened beverages or alcoholic drinks prior to the appointment, especially as these can be triggers for attacks (flares)
The doctor’s visit
Once at the doctor’s office, he or she will conduct a full medical review (i.e. medical history) and discuss the nature of symptoms experienced. To do this, a doctor normally asks a series of questions which help to either determine a potential cause of a problem or rule out others which can have similar effects.
Questions can include:
- What symptoms are being experienced?
- When did symptoms first appear and how long ago?
- How long did symptoms occur for? Did they occur continuously for a period of time? Did they come and go?
- How often has this set of symptoms occurred?
- Have symptoms occurred following a possible trigger such as food, emotional stress or several alcoholic beverages?
- Do you consume alcohol? If so, what, how often and how much (on average)?
- Are any other medical conditions currently being treated? If so, what is the condition and how is it being treated?
- Are any medications (prescription or over-the-counter) or supplements (including herbal varieties and vitamins) currently being taken?
- Have any family members experienced gout?
Various testing options can be recommended once a doctor has completed a physical examination.
Tests which can help a doctor diagnose gout (or gouty arthritis) include:
- Blood test: Levels of uric acid and creatinine (the breakdown substance of creatine phosphate in muscle tissue) can be measured via analysis of a blood sample. A sample will be drawn from a vein in the arm and tested. This test is used to check for the presence of uric acid, which in excess, could indicate a possible problem related to symptoms (this test is not normally a diagnostic evaluation on its own). High levels of uric acid in the bloodstream do not always indicate gout. The sample will also be assessed to check for overall kidney function and blood cell counts. It can happen that levels of uric acid lower during a gout attack, making the optimum time to check for elevated levels after the worst of an attack (flare).
- Joint fluid test (joint aspiration): A needle can also be used to extract fluid from the affected joint. This sample is then examined microscopically and checked for the presence of urate crystal formations, and a possible bacterial infection. This test is most often used to make a diagnosis of gout or to help rule out (or diagnose) similar conditions such as pseudogout, which will show deposits of calcium pyrophosphate crystals and not uric acid formations. Other conditions which can resemble gout, displaying similar symptoms include reactive arthritis (a reaction to infection), psoriatic arthritis (associated with the skin condition, psoriasis), and infectious / septic arthritis (infection in the joints causing arthritis-like symptoms).
- Imaging tests: A doctor may also recommend imaging tests to check for urate crystal formations. Options include X-rays (radiographs) of the affected joint/s which can clearly indicate signs of inflammation, a musculoskeletal ultrasound, or dual energy CT (computerised tomography) scan, which can pick up crystal formation even if the affected area is not inflamed. Imaging tests can also help to determine any potential damage to joints and tissues affected by gout flares.