Gout

Tests and diagnosis of gout

A diagnosis of gout is often made based on the symptoms that people have. These symptoms commonly include sudden onset of joint pain, heat, swelling and redness, usually in the early hours of the morning. To confirm the diagnosis, a sample of fluid from the affected joint or a tophus (a small firm white lump) can be taken using a needle. It is not necessary to confirm the diagnosis using a fluid sample when signs and symptoms clearly indicate gout. However, sometimes confirmation is needed when symptoms are unusual. 
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. Sometimes crystals can be found in a sample from the knee joint even if the individual has not had an attack in their knee. 

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.
As was the case for many people, Alan’s GP diagnosed gout by looking at his foot and feeling that it was hot. However, Simon was told by one GP that he had gout without the GP looking at the affected joint. Jeff Y’s GP could feel uric acid crystals in his ears and identified tophi (small white lumps) on his ear and hand. Shirley Y also had a lump on her foot that her GP thought was full of uric acid crystals. 
Some people had a blood test to check their uric acid levels. They were then diagnosed with gout when they went back to get their test results. Pat knew a bit about gout because she works as a nurse, so when she had been having bouts of pain in her toe joint for a while, she asked her GP for a blood test. Kate’s pain felt very similar to the pain she’d had when she was diagnosed as having calcium crystals in her knee. After a blood test, though, she was told that she had gout. 
Jeff Z was also diagnosed with gout. His father had experienced similar symptoms most of his life but they had been attributed to another form of arthritis. Jeff Z and his GP wondered whether he had actually had undiagnosed gout. 

Diagnosis was not straightforward for everyone, and not everyone got a diagnosis of gout to begin with. Ben’s GP told him that he had probably bruised his toe. Sue went to her local minor accident clinic and was told that her toe was inflamed. 
People who visited Accident and Emergency (A&E) or walk-in medical centres were often checked for fractures or septicaemia. Arthur was told that he might have been bitten on the foot, while Tony X was told by a consultant in A&E to visit his GP because he had gout. Michael had a camera inserted into his knee to find out what the problem was and uric acid crystals were found. He had to stay in hospital for five days until he could walk again after the procedure.  
Jean had previously had her toe joints replaced. When she began to have gout symptoms she saw a chiropodist and two GPs who found it difficult to understand how she could have gout. It also took several years for Paula to be diagnosed, and she believes that her GP did not realise how bad her symptoms were.
Some women were not immediately diagnosed because their GP thought it was unlikely that a woman would have gout. Jacqui was told by her doctor that a man with the same symptoms would have been diagnosed with gout. She now wonders if gout is under-diagnosed in women.
Jeff V was on holiday in Sri Lanka. He discussed his symptoms with people he met there who saw that he was limping. Together, they came to the conclusion that he had gout. The diagnosis was confirmed by his GP when he got home. Other people were diagnosed at a local clinic or surgery in the country they were on holiday in. Hazel was living in the Philippines when she first had symptoms. She did not go to a doctor for a diagnosis because both her parents and many other relatives had gout, so they saw it as a normal condition to have.
John Z and Peter X both had aching joints rather than the extreme pain described by other people. John Z was working as a doctor at the time, but had not come across anyone with the ‘mild gout’ symptoms that he had. His blood test showed high levels of uric acid, but he knows that a fluid sample would be needed to confirm the diagnosis. For this reason, and because of his less severe symptoms, he sometimes wonders if his diagnosis was correct. 

After diagnosis, some people realised that they had actually had less severe gout symptoms in the past, before their first major attack. 
When people had symptoms in a different joint from the one that their first attack affected, they sometimes did not realise that it was gout again. Alastair had his gout diagnosed during his first attack. His first and second attacks were both in his toe, so he knew what they were. His third attack affected his ankle and he did not realise that it was gout until it was diagnosed at his local walk-in medical centre. Tony Y had previously had painful attacks but then developed swellings on his elbow that were not painful. His GP diagnosed these as gout as well.


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Last reviewed December 2016
Last updated December 2016

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