Rheumatology

Answer 1 Microscopic examination of tissue aspirate. 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. REFERENCES 1. Schlesinger N, Baker DG, Schumacher HR Jr. Serum urate during bouts of acute gouty arthritis. J Rheumatol 1997; 24:2265-6. Click here to return to the questions

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