FMGE 2017 — Internal Medicine

Q: Which of the following is the best investigation for acute gout?

Uric acid in synovial fluid. ***Uric acid in synovial fluid*** - The definitive diagnosis of acute gout is established by identifying **negatively birefringent needle-shaped uric acid crystals** within the synovial fluid of the affected joint [1]. - This method directly confirms the presence of **monosodium urate crystals**, which are the hallmark of gout, offering diagnostic certainty [1]. *Uric acid in urine* - While urinary uric acid levels can help assess uric acid excretion, they are not diagnostic for acute gout and do not directly show the presence of **intra-articular crystals**. - This test is more relevant for investigating the **cause of hyperuricemia** (overproduction vs. underexcretion) rather than diagnosing an acute flare. *Anti CCP antibodies* - **Anti-cyclic citrullinated peptide (anti-CCP) antibodies** are markers for **rheumatoid arthritis** and are not relevant for the diagnosis of acute gout. - Their presence indicates an autoimmune inflammatory condition distinct from crystal-induced arthropathy. *Serum uric acid* - Serum uric acid levels are often elevated during an acute gout flare (**hyperuricemia**), but this is not diagnostic, as many individuals with hyperuricemia never develop gout [1]. - Approximately 30% of patients may have **normal serum uric acid levels** during an acute attack, making it an unreliable sole diagnostic criterion.

11 Questions — Page 2 of 2

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Q11

Which of the following is the best investigation for acute gout?

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