Fast Five Quiz: Gout and Pseudogout

Herbert S. Diamond, MD


December 04, 2019

Pseudogout attacks can be triggered by many metabolic abnormalities. Thus, patients who have an initial attack of arthritis with calcium pyrophosphate crystals should have a workup that includes a chemistry screen; serum magnesium, calcium, and iron levels; and thyroid function tests.

Gout is most often diagnosed clinically on the basis of the presence of monoarticular arthritis that is marked by swelling and redness and usually involves the first metatarsophalangeal joint. The American College of Rheumatology criteria are the most widely used for diagnosis. The most definitive studies for establishing the diagnosis of gout, synovial fluid aspiration and polarizing microscopy, are not commonly performed in these patients, as most cases are managed in primary or acute care settings. Moreover, in many cases, clinical criteria are sufficient to establish the diagnosis. Ultrasonography, MRI, and CT scanning are not typically necessary for diagnosis. Imaging may be useful to exclude fractures in patients with gout-like symptoms after a joint injury to identify chondrocalcinosis or for quantifying the extent of urate deposition.

Gouty attacks are not related to serum levels of uric acid. Thus, an elevated serum uric acid level does not prove the diagnosis of acute gout. Hyperuricemia is present in the vast majority of cases of gout; however, a normal level does not exclude the diagnosis.

Read more about the workup of gout and pseudogout.


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