Question

A 55-year-old Asian male presents with a history of severe left great toe pain. He states he cannot even touch the toe with a sheet without it causing pain. He denies trauma but states he cannot ambulate without pain. He admits to drinking alcohol but not to excess. On physical exam, he has normal vital signs, and you note erythema of the great toe at the interphalangeal (IP) joint. Which of the following is the gold standard for diagnosis of this problem?

1) Joint aspiration with crystal analysis.
2) Serum uric acid level.
3) X-ray.
4) Diagnosis is made with physical exam only.

Answer 1

Joint aspiration with crystal analysis is the gold standard for diagnosing gout, which is indicated by the severe toe pain and inflammation described by the patient.

Step-by-step explanation:

The gold standard for the diagnosis of gout, which is suggested by the severe pain in the left great toe and erythema at the interphalangeal joint, is joint aspiration with crystal analysis. This procedure involves extracting synovial fluid from the affected joint and examining it for the presence of monosodium urate (MSU) crystals. Serum uric acid levels, X-rays, and physical exams can support the diagnosis but are not definitive without the identification of MSU crystals in the joint fluid.