How is gout diagnosed?
Several other kinds of arthritis can mimic gout, so proper diagnosis is essential. Gout is suspected when a patient experiences joint swelling and intense pain followed, at least at first, by pain-free periods between attacks. Initial gout attacks often occur at night. A correct diagnosis may depend on finding the characteristic crystals. The physician will use a needle to extract fluid from an affected joint and examine that fluid under a microscope to determine whether monosodium urate crystals are present. Crystals also can be found in deposits under the skin (called tophi) that occur in advanced gout. Uric acid levels in the blood can be misleading, as these may be temporarily normal or even low during attacks. Uric acid levels also are often elevated in people who do not have gout.
