Medical History and Physical Exam for Gout

A medical history and a physical exam are often used to diagnose gout.

During the medical history, your doctor will typically ask about any:

• History of gout in your immediate family.
• History of sudden attacks of arthritis affecting one joint, especially the big toe, foot, ankle, knee, wrist, or finger.
• History of wrist or ankle sprains or tendinitis without having an injury or your symptoms go away on their own in about a week.
• Recent injury or surgery.
• Recent infections of the skin, kidney, bladder, or lung.
• Alcohol use.
• Exposure to lead.
• Recent diets.
• Medical conditions, including high blood pressure, high triglyceride levels, heart disease, kidney disease, and diabetes.
• Use of certain medicines, especially diuretics and aspirin.

During a physical exam, your doctor will:

• Take your temperature. Fever may accompany gout attacks.
• Examine the skin over the painful joint to see whether it is warm, tender, red, or peeling.
• Check the skin over the affected joint for cuts that may be a source of infection.
• Feel the joint to assess pain.
• Check the range of motion of the affected joint.
• Examine your hands, elbows, feet, ankles, knees, and earlobes for gritty, chalky clumps of uric acid crystals called tophi.

If your medical history and physical exam clearly suggest that you have gout, further testing may be postponed until treatment relieves pain and swelling or until subsequent attacks occur.

If the diagnosis remains unclear after the history and physical exam, your doctor may order a blood test to measure the level of uric acid in your blood. He or she may also order a joint fluid aspiration test to examine joint fluid for uric acid crystals.

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