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  • Q&A with Australian Health Practitioners

    How is gout diagnosed?

    Related Topics
    Gout Rheumatology
    • 2 answers
    • Dr Greg Sher
    • Dr Irwin Lim
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    Dr Greg Sher

    Chiropractor

    I am the Clinic Director of the Sydney Spine and Sports Clinic.At our clinic, we see an equal mix of city office workers and elite … View Profile

    The most important step in the diagnostic process is a good in-depth history about the problem, the patient, their lifestyle factors, and other related issues. 
    Once other pathologies can be excluded during the history, we would look to examine the affected joint. 
    It usually only affects one joint at a time, and would show us certain telltale signs. 

    The next steps would be to send for an X-Ray of the affected joint, and a blood test to determine if it is really gout, or another type of arthritis affecting the joint. 
    The blood test would look at Uric Acid levels. 

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    Dr Irwin Lim

    Rheumatologist

    Irwin has been a rheumatologist in Sydney since 2003. He is a co-founder and medical director of BJC Health, which consists of a team of … View Profile

    There are a few conditions that can look like gout. A definite diagnosis is made by demonstrating uric acid crystals from taking a sample of joint fluid using with a syringe and a needle during an acute attack. This is called joint aspiration. This can be tricky if the joint involved is a small one, as at the big toe.However, an experienced doctor can make a clinical diagnosis without a joint aspiration, based on the underlying risk factors for gout, the clinical presentation, and if possible, blood tests showing a high uric acid level, and an elevation of inflammatory markers such as the ESR and CRP.
    There is a caveat to this. It is not uncommon to see a normal blood uric acid level during an acute attack. Therefore a normal blood uric acid level does not exclude gout and it should be tested again a few weeks after the attack has settled. 

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