Dr Kola Tytler MBBS CertHE MBA MSt MRCGPClinical Lead • iatroX
To differentiate between gout and other forms of arthritis in a patient presenting with joint pain, consider the following:
- Suspect Gout Based on Presentation:
- Suspect gout in people presenting with rapid onset (often overnight) of severe pain, together with redness and swelling, in one or both first metatarsophalangeal (MTP) joints NICE NG219.
- Also suspect gout if tophi are present NICE NG219.
- Consider gout if there is rapid onset (often overnight) of severe pain, redness, or swelling in other joints, such as the midfoot, ankle, knee, hand, wrist, or elbow NICE NG219.
- For people presenting with chronic inflammatory joint pain, consider chronic gouty arthritis NICE NG219.
- Assess for Other Conditions:
- It is important to assess the possibility of septic arthritis, calcium pyrophosphate crystal deposition, and inflammatory arthritis in people presenting with a painful, red, swollen joint NICE NG219.
- If septic arthritis is suspected, refer immediately according to the local care pathway NICE NG219,NICE CKS.
- Diagnostic Steps:
- Take a detailed history and carry out a physical examination to assess symptoms and signs NICE NG219.
- Measure the serum urate level to confirm the clinical diagnosis, with a level of 360 micromol/litre (6 mg/dl) or more being indicative NICE NG219.
- If the serum urate level is below 360 micromol/litre (6 mg/dl) during a flare and gout is strongly suspected, repeat the measurement at least two weeks after the flare has settled NICE NG219.
- Consider joint aspiration and microscopy of synovial fluid if a diagnosis of gout remains uncertain or unconfirmed NICE NG219.
- If joint aspiration cannot be carried out or the diagnosis remains uncertain, consider imaging the affected joints with X-ray, ultrasound, or dual-energy CT NICE NG219.
- Referral to Specialist Services:
- Consider referring a person with gout to a rheumatology service if the diagnosis of gout is uncertain NICE NG219,NICE CKS.