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Synovial Fluid Analysis for Diagnosis of Intercritical Gout

Eliseo Pascual, MD, PhD; Enrique Batlle-Gualda, MD, PhD; Agustín Martínez, MD; José Rosas, MD; and Paloma Vela, MD, PhD
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From Hospital General Universitario de Alicante, Hospital de la Marina Baja, and Hospital General de Elche, Alicante, Spain.


Acknowledgment: The authors thank Dr. Laura Fry for her help with the English version of this manuscript and for useful comments on the text.

Grant Support: In part by Fondo de Investigación Sanitaria grant 96/1212.

Requests for Reprints: Eliseo Pascual, MD, PhD, Hospital General Universitario de Alicante, Maestro Alonso 109, 03010 Alicante, Spain; e-mail, e.pascual@san.gva.es. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Drs. Pascual, Batlle-Gualda, Martínez, and Velda: Hospital General Universitario de Alicante, Maestro Alonso 109, 03010 Alicante, Spain.

Dr. Rosas: Hospital Marina Baja, Partida Galandu 5, 03570 Villajoyosa, Alicante, Spain.


Ann Intern Med. 1999;131(10):756-759. doi:10.7326/0003-4819-131-10-199911160-00007
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Background: The diagnosis of gout in the intercritical phase can be difficult.

Objective: To determine whether synovial fluid analysis allows the diagnosis of intercritical gout.

Design: Cross-sectional study.

Setting: Outpatient rheumatology clinics.

Patients: 101 patients with gout.

Intervention: Arthrocentesis of 80 knees and 21 first metatarsophalangeal joints (each joint from a different patient) that had been inflamed but were currently asymptomatic.

Measurements: Frequency with which arthrocentesis yielded synovial fluid; presence of monosodium urate crystals in the synovial fluid sample; and, for synovial fluid with crystals, the number of microscope fields that had to be scanned before crystals were found.

Results: Synovial fluid was obtained from 91 of 101 joints. The fluid from all 43 patients not receiving hypouricemic agents contained monosodium urate crystals. These crystals were found in the synovial fluid of only 34 of 48 patients receiving hypouricemic agents. In 90% of the synovial fluid samples that contained crystals, crystals were seen in the first five microscope fields examined.

Conclusions: Arthrocentesis of asymptomatic knees and first metatarsophalangeal joints and synovial fluid analysis are simple procedures that facilitate the diagnosis of gout during intercritical periods.

Figures

Grahic Jump Location
Figure.
Presence (white bars) or absence (striped bars) of monosodium urate crystals in synovial fluid according to the time elapsed since the last gout attack.Top.nBottom.nP

Patients not receiving hypouricemic agents ( = 43). Patients receiving hypouricemic agents ( = 48). * < 0.001.

Grahic Jump Location

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Summary for Patients

Diagnosing Gout between Painful Episodes

The summary below is from the full report titled “Synovial Fluid Analysis for Diagnosis of Intercritical Gout.” It is in the 16 November 1999 issue of Annals of Internal Medicine (volume 131, pages 756-759). The authors are E. Pascual, E. Batlle-Gualda, A. Martínez, J. Rosas, and P. Vela.

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