Other sites, such as foot, knee, hand, or shoulder, may also be involved. Acute attack lasts 3 to 10 days without treatment. It may be difficult to differentiate from a septic joint, and so joint aspiration for synovial fluid examination is critical, especially with the first attack. Overindulgence in food and emotional stress may also trigger attacks. Recommendation is to demonstrate crystals in joint aspirate.
Urate crystals are rod or needle shaped and negatively birefringent.
Crystals may be recovered from joints during asymptomatic periods. Examined fluid should be sent for Gram stain and culture to rule out infection. Serum uric acid levels are generally not helpful in acute attacks and may be normal. Steroids are another option for acute treatment. There is no advantage to using ketorolac in an acute flare of gout.