How to increase the yield of finding uric acid crystals in a patient who clinically has gout

How to increase the yield of finding uric acid crystals in a patient who clinically has gout?

Rarely, you may encounter a patient who clinically has gout but you cannot find crystals on synovial fluid examination.

Some “tricks” that have been tried are to centrifuge the fluid and examine the centrifugate for crystals (especially helpful for CPPD crystals). Another trick is to cool the fluid in the refrigerator, although this usually does not work. Finally, putting fluid on a microscope slide and allowing it to dry for 2 to 3 hours may allow overhydrated uric acid crystals to dehydrate and be drawn toward each other to form spherules that are easier to see.

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