What is the gold standard for diagnosing gout?

The gold standard for diagnosing gout is joint aspiration with crystal analysis. This procedure involves withdrawing synovial fluid from the affected joint and examining it under a microscope to identify the presence of monosodium urate crystals. These crystals are indicative of gout and provide definitive evidence of the condition, which is characterized by the accumulation of uric acid in the joints leading to inflammation and pain.

While serum uric acid levels can be a useful test and can indicate hyperuricemia, they are not definitive for diagnosing gout, as uric acid levels can fluctuate and may be normal during an acute attack. X-rays may be used to assess joint damage or changes over time, but they do not confirm the presence of gout. Diagnosis by physical examination is often based on clinical signs and symptoms but lacks the specificity and reliability that joint aspiration provides. Thus, joint aspiration with crystal analysis remains the most accurate and reliable method for confirming a diagnosis of gout.