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Mariano Andrés, Eliseo Pascual, Paloma Vela, Comment on: The validation of a diagnostic rule for gout without joint fluid analysis: a prospective study, Rheumatology, Volume 54, Issue 7, July 2015, Pages 1328–1329, https://doi.org/10.1093/rheumatology/kev132
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Sir, Ideally, diagnosing a disease implies recognizing its possibility under all the forms in which it can present; being able to distinguish it from other diseases that can share a similar presentation; and also ascertaining that all diagnoses are correct. Fortunately this is possible in gout, a disease resulting from the deposition of MSU crystals in the surface of the articular cartilage and other tissues. The crystals are easily identifiable by microscopy in the SF of joints stricken by gout attacks and also in asymptomatic joints previously inflamed [1] if the patient has not been treated with urate-lowering drugs; also the crystals can be detected by needling a tophus. Although US is not yet at the level of providing an accurate diagnosis it allows the location of crystal aggregates or inflammation in joints less suitable for blind arthrocentesis, thus allowing them to be sampled for crystal analysis. In a proper setting, unequivocal gout diagnosis appears to be always possible with few exceptions.
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