When the patient’s main complaint is acute inflammation of a single joint, the analysis of the synovial fluid from the joint after withdrawal is decisive and decisive, in order to exclude inflammation of the joints due to infectious infection and to confirm the diagnosis of gout or false gout by identifying the crystals . In gout cases, uric acid crystals are identified in the synovial fluid. The presence of these crystals with polarizing light microscopy confirms the diagnosis.
In the case of gout, the crystals are monohydrate sodium urate crystals, which are like needles and are pointed on both sides. When the polarization test is yellow when the radiation is parallel and blue when it is vertical and therefore negative birefringence, in the case of false gout, the crystals are Calcium pyrophosphate is formed in the form of non-sharp rods-like. When polarization is examined, it is blue when the radiation is parallel and yellow when it is vertical and therefore is a positive birefringence. It is possible to cultivate the synovial fluid for the possibility of inflammation of infection and gout, especially chronic gout at the same time with the work of an allergic reaction to antibiotics, and the examination of the allele of the question of albumin refers to an increase in white blood cells, especially in acute attacks of the disease and the level of sugar in the natural fluid to reverse What is in the bacterial arthritis (septic arthritis) and the level of sugar is low.
The examination of uric acid in the blood is important in the diagnosis but is misused. The presence of an increase in uric acid with no symptoms does not mean the presence of gout. Studies indicate that 10% of patients with gout and complain of symptoms, the level of uric acid in the blood is normal during It is worth mentioning that people who have high uric acid (more than 7 mg / dL) have 5-20% of them gout. And some patients with bacterial arthritis may have a high level of uric acid in their blood, and may make a mistake in the diagnosis if the withdrawal of synovial fluid and examination, and in general, people who have no symptoms do not give treatment, and when the increase of uric acid blood for 11 Mg / dL and with increased urinary excretion should be performed renal function test because these people are ready to be kidney stones and kidney failure, and with the high proportion of uric acid in blood the risk of gout is contained.
Urine acid is used in urine within 24 hours when the patient is given the medicine that increases the uric acid production in the blood. When excretion of more than 800 mg / 24 hours, allopurinol should be given instead of propenecid to reduce the acid level In addition, when excreting more than 1,100 mg / 24 hours, the kidney function should be examined. The risk of kidney stones, renal impairment and renal failure is due to deposition of acid salts in the kidneys. Patients with a history and history of kidney stones or kidney stones They do not give propanase, and give them alopurinol Without the need to check the uric acid within 24 hours.
There are also some important tests that must be done, including the work of examining the functions of the kidneys before making the decision to treat gout, and check the level of sugar in the blood to increase the chance of diabetes in patients with gout. It is also important to check liver function because abnormal functions affect the selection of appropriate treatment.
Also, white blood cells are high in the blood, especially during the acute seizure, which includes more than a joint, and there is a rise in triglyceride and low in HDL (high density lipids)
X-rays are often in the early stages of the disease, or appear to be swollen in soft tissue swellings. The results of the imaging characteristic of the disease, they appear after the first year of the presence of the disease and include distinctive erosion (ponshed-out erosion) or the area of the decomposition of the bone (lytic area) with the edges hanging. Ultrasound, a class image or a magnetic resonance image can also be used to see changes in the joint.
The stratified image can also be used to detect the presence of gravel in the kidneys.