Gout laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A definitive diagnosis of gout is made from light microscopy of the fluid aspirated from the joint. The fluid demonstrates intracellular negatively bi-refringent monosodium urate crystals and polymorphonuclear leukocytes in the synovial fluid. Although hyperuricemia is a common feature of gout, a high uric acid level does not necessarily mean a person will develop gout.

Laboratory Findings

While synovial fluid analysis remains the central pillar of diagnostic work up for all patients with new-onset acute monoarthritis, other laboratory investigations contribute to assist the diagnosis of gout, and in assessing comorbid conditions which affect gout.

The serum uric acid level during an attack of gout
  Sensitivity Specificity
> 5.88 mg/dl[1] 95% 53%
≥ 6 mg/dl[2] 86% ?
≥ 8 mg/dl[2] 68% ?

Serum uric acid concentrations[1][2][3]

  • Uric acid level is only useful to assist with clinical diagnosis of gout in symptomatic individuals as hyperuricemia alone is not sufficient.
  • It is less significant in diagnosing gout, especially during an acute attack when urate excretion through the kidneys is often increased.
  • The levels are important during urate lowering therapy when the goal is to maintain a target urate level.

 Blood tests:

  • Acute phase reactants, such as C-reactive protein, are usually increased during a flare—concentrations can be higher than 100 mg/L.[4]
  • Complete blood counts showing neutrophil leukocytosis can also be present depicting degree of systemic inflammation.[5]

 Renal function tests

  • Renal function tests are recommended when prescribing and monitoring drugs used for urate lowering therapy.

References

  1. 1.0 1.1 Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M (2010). "A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis". Arch Intern Med. 170 (13): 1120–6. doi:10.1001/archinternmed.2010.196. PMID 20625017.
  2. 2.0 2.1 2.2 Schlesinger N, Norquist JM, Watson DJ (2009). "Serum urate during acute gout". J. Rheumatol. 36 (6): 1287–9. doi:10.3899/jrheum.080938. PMID 19369457. Unknown parameter |month= ignored (help)
  3. Brauer GW, Prior IA (October 1978). "A prospective study of gout in New Zealand Maoris". Ann. Rheum. Dis. 37 (5): 466–72. PMC 1000277. PMID 718280.
  4. Roseff R, Wohlgethan JR, Sipe JD, Canoso JJ (October 1987). "The acute phase response in gout". J. Rheumatol. 14 (5): 974–7. PMID 2448456.
  5. Dalbeth N, Merriman TR, Stamp LK (October 2016). "Gout". Lancet. 388 (10055): 2039–2052. doi:10.1016/S0140-6736(16)00346-9. PMID 27112094.

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