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December 5, 1977

Acute Gouty ArthritisThe Diagnostic Importance of Aspirating More Than One Involved Joint

JAMA. 1977;238(23):2526. doi:10.1001/jama.1977.03280240072027

MONOSODIUM urate crystals in synovial fluid aspirated from a person with an attack of acute arthritis is the sine qua non for diagnosis of gout.1 However, in an occasional patient with acute gout, urate crystals cannot be found in fluid from the aspirated joint.2 A case of gout was found in a man with two nonadjacent sites of acute arthritis, one yielding synovial fluid with urate crystals, the other without urate crystals.

Report of a Case  A 31-year-old man was admitted to the emergency room of the University of Connecticut Health Center with complaints of pain and swelling of three days' duration in the right ankle and knee. History included a similar episode of pain and swelling in his right ankle and knee 1 1/2 years before this admission. At that time, he was told he had "arthritis or gout." Diagnostic studies were not performed, nor was aspiration