Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
This is the most important diagnostic test. It is the ultimate
method of being certain of a diagnosis of gouty arthritis, as opposed to other
causes such as an infection in the joint.
A needle is inserted into the joint to withdraw a
sample of fluid for testing.
The fluid is examined under a microscope to see if there are gout
crystals or signs of a bacterial infection present. Sometimes other crystals can be found
in the joint fluid, such as calcium pyrophosphate, which is caused by an entirely different condition called pseudogout ("like gout").
Gouty arthritis is sometimes diagnosed based on the typical clinical presentation without a joint aspiration.
Your doctor may obtain a blood sample to look at your
cell counts, uric acid levels, kidney function, etc.
Unfortunately, the level of uric acid in your blood cannot be reliably used to make a diagnosis of gout. It is normal in approximately 10% of people during an acute attack of gouty arthritis. Moreover, uric acid levels are elevated in 5%-8% of the general population, so the presence of an elevated level does not necessarily mean that gout is the cause of an inflamed joint. Interestingly, the uric acid is typically lowered during a flare of inflammatory gouty arthritis. Therefore, the optimal time to measure the uric acid is after a flare has resolved when acute inflammation is not present.
X-rays are primarily used to assess underlying joint damage, especially in
those who have had multiple episodes of gouty arthritis.
Gout is a common disorder of uric acid metabolism that can lead to deposition of monosodium urate (MSU) crystals in soft tissue, recurrent episodes of debilitating joint inflammation, and, if untreated, joint destruction and renal damage.