1) Joint aspiration/arthrocentesis
This is a really important diagnostic investigation especially in ruling out ‘gouty arthritis’ and differentiates it from inflammation that is due to infection in the joint.This test is done by inserting a needle into the joint and withdraw an amount of fluid, in which afterwards being observed under the microscope. The fluid will be examined for any presence of uric acid crystal which is indeed an important marker for gout. Signs of bacterial infection also need to be checked. Other types of crystal can also present in the aspirated fluid, such as calcium pyrophosphate in a condition called ‘pseudogout’ (like gout). Sometimes, gouty arthritis can be diagnosed based on the typical clinical presentation without doing this invasion method.
Arthrocentesis
2) Blood test
This test comprises of full blood count, renal profile, and level of uric acid in the blood.
Full blood count concerned on the white blood cell count, is measured in order to rule out infection as the causes of inflammation. However, the level of uric acid in blood is not reliable in gout diagnosis. Why is this so? This is because approximately 10% patients have a normal uric acid level during an acute attack of gouty arthritis. Besides, in 5-8% out of general population have high uric acid (hyperuricemia) in their blood. Thus, this means that high uric acid in blood does not necessarily mean gout is the cause of inflamed joint. Remarkably, during a flare of inflammatory gouty arthritis, the amount of uric acid in the blood is rather low. So, usually level of uric acid in blood is measured after a flare has resolved when acute inflammation is absence.
3) Radiographs
Patients who had recurrent episodes of gouty arthritis will develop joint damage. In order to assess this underlying damage, x-ray of the joint can be carried out.
X-ray of a foot with numerous interosseous tophi
X-ray of a hand with visible swellings around the affected joints
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