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The symptoms of gout tend to happen suddenly and often at night. Gout can cause a sudden severe attack of burning pain, stiffness, redness and swelling in a joint, usually a big toe. It is important to note that you can also get attacks in other joints like ankle, elbow, or knee, which can happen repeatedly unless treated.
The pain tends to be at its worst in the first four to 12 hours after it starts. Even after the most severe pain goes away, some joint discomfort can remain for a few days to as long as a few weeks. If gout is allowed to progress untreated, the person’s range of motion becomes increasingly limited. The skin around the joint may also start to peel and itch as the joint gets better.
In some people, gout does not cause intermittent painful attacks. Rather, they have gout all the time. This form, called chronic gout, may not be as painful and may be confused with other forms of arthritis.
There are three main tests that may be used to diagnose gout:
X-ray imaging: In this test x-ray imaging is used to see if tophi (deposits of uric acid crystals) are found on joints. Plain films frequently reveal classic erosions associated with tophi. This can reduce the need for a more invasive joint aspiration for diagnosis.
Joint fluid test: In this test a doctor draws synovial fluid from a joint to check for uric acid crystal formation. Sometimes doctors might see calcium pyrophosphate formulation with indicates pseudogout.
Blood test: Blood tests for gout look at uric acid levels. Normal ranges of uric acid is between 3.5-7.2mg/dl (some labs have a variation in normal range so talk with your doctor if you have any questions). For people with gout treatment aims to keep uric acid levels at 6mg/dl or less.
According to CreakyJoints medical director Dr. Krant, “We like to look at both plasma urate concentration in addition to the 24 hour urine urate to determine whether a patient is an over producer or under excretor of uric acid. This has therapeutic implications. Specifically, we will give a uricosuric agent such as probenecid for someone who is not putting out adequate amounts of uric acid in the urine. Xanthine oxidase inhibitors (albuterol and Uloric) do a fine job of lowering the uric acid concentration”