Although most of the choices can be helpful in diagnosing gout, the gold standard for diagnosis is direct visualization of uric acid crystals under a microscope. This is easily done by obtaining a small amount of aspirate from a swollen joint or, in this case, a tophus. A uric acid level obtained by a 24-hour urine collection may be normal or elevated in patients with gout, as can a serum uric acid level.1 Radiographs may show classic changes of gouty bone erosions, such as rat bite or overhanging edges; however, they cannot establish the diagnosis irrefutably. Rheumatoid factor appears to become elevated with age, but this measurement on its own does not denote any specific condition.
- Microscopic examination of tissue aspirate.
1. Schlesinger N, Baker DG, Schumacher HR Jr. Serum urate during bouts of acute gouty arthritis. J Rheumatol 1997;
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Seminars in Medical Practice
Hospital Physician Board Review Manuals
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