Diagnosis of gout in general practice.

In a general practice survey of gout, an analysis was made of the criteria relating to the diagnosis in 604 patients. Approximately 60% of diagnoses were made within 1 month of the patient presenting with symptoms; in the remainder, there was often a considerable time lag before diagnosis and half of these patients had been wrongly diagnosed initially. Of the total cases, approximately 8% were diagnosed in hospital and only about 20% of cases were referred for diagnosis or subsequent management advice. Most diagnoses were based on the presentation by the patient of a typical acute arthritis, and a raised serum urate level was used as a confirmatory factor. Few patients presented with tophi and response to colchicine was infrequently used in diagnosis, as were diagnostic X-rays or synovial fluid examination for crystals.