Acute Gout: ACP Provides Guideline on Diagnosis
Am Fam Physician. 2017 Dec 1;96(11):746.
Author disclosure: No relevant financial affiliations.
Key Points for Practice
• Synovial fluid analysis should be used to diagnose gout when the joint can be aspirated without significant patient discomfort.
• Synovial fluid analysis should also be performed when the clinical situation is uncertain and a probability of infection exists.
• A polarizing microscope and a trained operator are needed to detect the presence of urate crystals.
From the AFP Editors
Gout is caused by excess urate crystals that accumulate in body tissue and fluid. This results in inflammatory arthritis. It is important to correctly diagnose and distinguish gout from other inflammatory arthritic conditions because treatments differ. The diagnostic standard for acute gout is joint aspiration with synovial fluid analysis for monosodium urate crystals; however, many patients are seen in a primary care or emergency medicine situation where synovial fluid analysis is rarely performed. The American College of Physicians (ACP) has developed a guideline for diagnosing adults with joint inflammation suspected to be gout.
The ACP recommends that all clinicians use synovial fluid analysis when diagnostic testing for gout in adults with joint inflammation is needed based on clinical judgment. Although the ACP recognizes that it is difficult to perform this test in a primary care setting, it remains the diagnostic standard for acute gout. A misdiagnosis or delayed diagnosis can lead to unnecessary surgery or hospitalization, delays in treatment, and needless prescribing of long-term treatment.
Synovial fluid analysis should be used when the joint can be aspirated without significant patient discomfort and should be performed by an experienced physician who can minimize the risk of infection. A polarizing microscope and a trained operator are needed to detect the presence of urate crystals. Synovial fluid analysis should also be performed when the clinical situation is uncertain and a probability of infection exists. If the physician cannot meet
This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
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