How is Gout Diagnosed

How is Gout Diagnosed?

The demonstration of MSU crystals in aspirates of synovial fluid or tophi remains the gold standard for diagnosis. Intracellular or extracellular MSU crystals are needle-shaped, approximately the size of a white blood cell, and are strongly negatively birefringent (yellow when parallel to the axis of a red compensator) on polarized microscopy (Arthrocentesis and Synovial Fluid Analysis). MSU crystals can be identified in joint aspirates during intercritical (asymptomatic) periods. Synovial fluid during a gout flare is inflammatory (typically 20,000–100,000 leukocytes/mm 3 ) with a predominance of neutrophils. Septic synovial fluids may contain MSU crystals; therefore, it is important to obtain a Gram stain and culture to rule out concomitant septic arthritis. This is particularly important as gout flares may present with overlapping signs and/or symptoms of infection such as low-grade fever, elevated acute phase responses, and mild leukocytosis.

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