Test for Gout

If you have experienced severe pain and high levels of inflammation in one joint and you have no known injuries or medical conditions that could cause such pain, you may want to be tested for gout. Gout happens when too many uric acid crystals form around a joint, causing pain. Most patients with gout experience pain in the joint of the big toe first, but any joint can be affected. To test for gout, your doctor will most likely use a joint needle aspirate test or a blood or urine test.

Steps

Preparing for an Appointment with the Doctor

1. Complete a medical history. Medical conditions such as diabetes, high blood pressure (if left untreated), and problems with your heart or kidneys can leave you more susceptible to gout.
   • Similarly, treatments for certain cancers can cause gout, such as leukemia and lymphoma.
   • Also, make sure you note any severe illnesses, infections, or trauma you've had, especially if they occurred recently.
2. Find out if you have a history of gout in your family. If so, you may be genetically predisposed to the condition. Ask your parents if they know if anyone in the family has had gout.
3. Have a list of your medications ready. As with any doctor's appointment, your healthcare provider will want to know the medications you're on. Sometimes medications can cause side effects that you aren't aware of or they can actually lead to a medical condition. They may be causing the problem you're visiting the doctor for. Also, your doctor needs to know if a medication she prescribes will interact with another medication you are on.
   • For example, loop or thiazide diuretics and low-dose aspirin can both contribute to your risk for gout.
4. Make note of your symptoms. Jot down when you are having pain, such as twice daily or only in the evenings. Also, write down where you are having pain, such as your knees or your big toe. Note any other symptoms you may be having, such as redness, swelling, and limited range of motion or tenderness in certain joints.
5. Keep a food diary. A food diary is a list of the foods you eat in a day and an approximation of how much of them you eat. For instance, you could write down that you ate 6 ounces of steak for dinner, along with 1/2 a cup of broccoli, and 1/2 cup of mashed potatoes with 1/2 a tablespoon of butter.
   • A food diary could be important when diagnosing gout because you can be at a higher risk for gout if you consume large amounts of meat, alcohol, or high fructose foods.
6. Jot down any questions you have. For instance, maybe you want to know if the pain could be caused by another type of arthritis. Similarly, you may have a question about a medication causing joint pain. Write those questions down so you don't forget them when you talk to your doctor.

Testing for Gout

1. Be ready for questions. One of the main ways your doctor will diagnose you is through questions. Use the notes you made of your symptoms to provide answers to the doctor's questions.
   • For instance, gout is a more likely diagnosis if you had it first in your big toe and then it moved to other joints, so your doctor may ask you about where your pain is.
2. Expect a joint needle aspirate test. This is the most common type of test used. In this test, your doctor uses a needle to extract synovial fluid from your joint. He then looks at it under a microscope to check it for sodium urate crystals, a sign of gout.
3. Be ready to give a blood sample. Blood samples are another common way to test for gout. You will be tested for the level of uric acid in your blood. However, this test has some problems, as you can have high levels of uric acid without having gout. You can also have gout without your levels of uric acid being high.
   • In fact, some times your doctor will not test your blood until about a month after your suspected gout attack, as the serum uric acids may not be elevated until that point.
   • A urine test is sometimes used for this same purpose. Essentially, you will be asked to urinate in a clean cup at the doctor's office. A technician will check your urine for its uric acid levels.
4. Understand why your doctor may order an ultrasound. Your doctor can use an ultrasound to detect urate crystals in your joints and skin. An ultrasound may be used when you are experiencing acute intermittent pain and if one or more joints are affected. If you are adverse to needles, you may want to ask for an ultrasound instead of a joint needle aspirate test with a needle.
5. Ask your doctor to check for other causes. If you think your joint pain is not caused by gout, you can ask your doctor to check for other causes. She will likely use X-rays to see if your joints are inflamed, which indicates another problem.

Treating Gout

1. Try pain medications. Your doctor will likely recommend pain medications, from over-the-counter pills you probably already have to prescription pain medications.
   • For severe gout, you may be prescribed pegloticase (Krystexxa).
   • NSAIDs are commonly used to treat gout, from prescription celecoxib to over-the-counter ibuprofen.
   • Your doctor might also prescribe the pain medication colchicine, though the side effects are so severe for some people that it may not be the best option for you.
2. Ask about corticosteroids. These steroid medications can also provide relief for gout, especially if you can't take NSAIDs. You can either have the medication injected into the joint, or you can take it orally if the pain is more widespread.
3. Expect a medication for prevention. If you are having repeated attacks, your doctor is likely to prescribe you a drug for preventing gout. These drugs fall into two categories, ones that block uric acid from being produced and ones that help remove more uric acid from your system than your body is able to do on its own. Common medications are allopurinol, febuxostat, and probenecid.
4. Slow down on the alcohol and fruit juices. Alcohol and drinks with fructose in them can make gout worse. Try to replace these drinks with water as often as possible
5. Lower your intake of meat and certain seafood. Certain meats can increase uric acid in your body. Uric acid is created when your body processes the chemical purine, and some meats and seafood are high in purine.
   • Try to avoid beef, pork, and lamb, especially. You should also avoid seafood such as anchovies, herring, and shrimp and other types of shellfish. Organ meats, such as liver, heart, and kidney, are also high in purine.
6. Stick to an exercise routine. Exercise can help lower your body weight and keep you healthier overall. Since obesity is a risk factor for gout, lowering your body weight will decrease your risk.
   • Choose a low-impact exercise, as gout can make it painful to exercise. Try swimming or walking. Aim to exercise regularly, at least 30 minutes 5 times a week.
7. Have surgery as a last resort. Tophi are large deposits of urate crystals that form on various parts of your body, creating lumps below the skin. They are usually found around joints and bones. If you let gout go untreated, you can develop large enough tophi that you need to have surgery to remove the tophi, as they can restrict your joints' range of motion. Kidney stones are another complication because they can block a ureter and lead to hydronephrosis.

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