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In a gout test, a pathologist will examine a sample from a patient to check uric acid levels. The doctor may also request x-rays of the patient's toe to check for signs of gout-related injury, and can also perform a physical examination. Test results are not always conclusive. The doctor may decide to treat the condition like gout even if the test does not categorically determine that the patient has this joint condition.
The best gout test is a synovial fluid sample. In this test, the doctor inserts a needle into the toe joint to collect a sample of fluid. The pathologist can check it for the telltale uric acid crystals seen in the joints of gout patients. During a flareup, however, it can be hard to get fluid from the toe, and thus this test is not always possible. If the test would be too painful or the patient doesn't have enough fluid, the doctor may recommend an alternate gout test or suggest testing again in the future.
Another option is a blood test. Some patients with gout have elevated uric acid levels in their blood. It is important to be aware that a higher level does not necessarily mean a patient has gout, as some medications can alter blood chemistry. Conversely, having a normal or low level does not mean gout is not present, as some patients who definitely have gout have normal blood levels. Thus, this test can be helpful, but not categorical.
X-rays are useful as a gout test in patients with advanced disease. Chronic gout will lead to erosion of the structures inside the joint, and this can be clearly visible on x-ray. The doctor can recommend this option for a patient with a history of joint pain and signs of gout. No signs of visible damage may indicate that the patient's case is mild or new, and thus hasn't caused enough damage to be visible on x-rays yet.
Depending on the method, a gout test can cause some discomfort and irritation. The synovial fluid sample may be very painful, as the toe joint is already tender and the doctor may need to probe with the needle to get a clean sample. The blood test should be relatively painless, as long as the technician has adequate training in drawing blood samples. X-rays should not be painful, although sometimes the patient may find it uncomfortable to hold still in the right position.