Uric acid test is the fifth step in the I Have Gout program. Earlier, we prepared an extensive list of symptoms. Now we need to discuss those symptoms with our doctor, and arrange for some uric acid tests.
Your uric acid test is often the first look at your gout symptoms by your doctor. He should have noted your symptoms in terms of which joints are affected, and the degree of pain you are experiencing. He should also have inspected any lumps (gouty tophi). Your uric acid test is the best way to reach a clear diagnosis about your gout. However, there are some complications you might need to consider, and you need to be aware of different tests.
Uric Acid Test: Blood
The most common way for gout to be diagnosed is by measuring the level of uric acid in your blood. There can be complications, but this test is usually very straightforward.
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If your uric acid level is above 5mg/dL, and your swollen joint is typical of a gout attack, then it is almost certain that you have gout. This is even more certain if there is a history of gout in your parents, siblings, or other close family members. If your blood test results are not certain, beware of the complications.
Uric Acid Blood Test Timing
When we have a gout attack, uric acid has moved from the blood into the joint. This can cause uric acid blood test results to be understated. If your uric acid is around 4mg/dL, but you suspect gout, repeat blood tests every 2 to 4 weeks, being careful to include times when you do not have a gout flare.
Uric Acid Blood Test Temperature
Rarely, gout can occur at lower than 5mg/dL due to low temperatures. This is more common as we get older, especially with poor circulation. It can also occur when people are subject to low temperatures because of their occupation or local cold climate. The safe level of 5mg/dL only applies at normal body temperature.
Uric Acid Blood Test Results
The biggest problem with the uric acid test for blood is that many doctors do not understand the results! When labs report results, they include a reference range that refers to the samples that the lab used when setting up their data. This might have some value for statisticians, but it is absolutely useless for medical purposes. Never accept a blood test result that is described as “normal,” “high,” or some other label. These labels mean nothing. You must insist on the number.
Uric Acid Test: Joint Fluid
Wherever there are complications in the uric acid blood test, it is best to consult a rheumatologist to test joint fluid. The uric acid test for joint fluid is generally regarded as the current gold standard for gout diagnosis. Newer imaging tests might supersede this standard, but currently, joint fluid analysis is best. It is not 100% reliable, as sometimes uric acid crystals exist in the joints, but are insufficient to count. Other problems include:
- Insufficient joint fluid
- Delay between drawing the sample and analyzing it
- Inexperienced analyst who does not recognize uric acid crystals
If the joint fluid analysis reveals uric acid crystals, you definitely have gout. However, for the reasons mentioned, a negative result does not prove that you do not have gout.
Uric Acid Test: Urine
If either the blood or joint fluid tests show that you have gout, there is another test available to try to determine why you have it. Gout occurs because we have too much uric acid, but there are two reasons why this can happen. The most common reason is that we produce too much uric acid. The less common reason is that our kidneys do not excrete enough uric acid. The common uric acid lowering medications, allopurinol or Uloric (febuxostat), will help both under-excreters and over producers. For that reason, most doctors do not bother with this test. For the small minority of people who cannot tolerate the common medications, this urine test can be useful. Urine is collected for a 24-hour period, and analyzed for uric acid content. If this is low, there are drugs called uricosurics that help promote uric acid excretion. Probenecid is the most common of these.
Uric Acid Test: Imaging
There are several new techniques in ultrasound and CAT scans that can identify uric acid deposits without the invasive joint fluid analysis. These are not widely available yet, but your rheumatologist might have access to them.
Uric Acid Test: Next Steps
In this step, you have worked with your doctor to arrange uric acid tests. You will need to wait for test results, and be prepared for retests if results are inconclusive. If you are unsure about any uric acid test, you can discuss it in the gout support forum.
You are now ready for I Have Gout 6: Gout Diagnosis At Last. However, if you are unsure, you can return to previous steps and reinforce any points you are not confident about.
Leave Uric Acid Test to browse other steps in the I Have Gout program.