Can this patient be diagnosed with gout without joint aspiration?
Clinic, ER, Hospital
Remember to always consider alternate diagnoses like septic arthritis if there is a concern for this ( systemic features, increased age, history of rheumatoid arthritis, skin infection, joint prosthesis, immunosuppression or atypical presentation)
If gout is suspected, use the following validated scoring system:
- Male Sex (2 points)
- Previous patient reported arthritis attach (2 points)
- Onset within 1 day (0.5 points)
- Joint redness (1 point)
- Involvement of the 1st MTP joint (2.5 points)
- Hypertension or >1 Cardiovascular diseases* (1.5 points)
- heart failure
- Serum uric acid >350 mmol/L (3.5 points)
>8 points: Likelihood of gout is >87%, and joint aspirate is unnecessary for a considering management as per guidelines using NSAIDs, Colchicine, and urate lowering therapy where appropriate
Confirmation can always be performed with joint aspirate where appropriate (gold standard for definitive diagnosis)
- Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PM, van Weel C, Janssen M. A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. Arch Intern Med. 2010; 170: 1120-1126.