Joint Aspiration: Is It Gout and What to Expect?

Joint aspiration

Doctor...
I went to the hospital yesterday to have joint fluid extracted, but they couldn't get any.
The swelling in my left foot has not gone down for 2 to 3 months; sometimes it hurts, and sometimes it doesn't.
I used to have swelling in my right index finger, but it seems to have shifted to a different area now.
I've had this issue for over 7 years.
Recently, I had my uric acid levels tested twice; once it was 12 and the other time it was 9.
During the time my uric acid was 12, I felt extremely unwell, with swelling in both knees and my toes.
I would like to ask the doctor if this is gout? Also, is the swelling in my left foot a gout tophus? Do tophi only accumulate in the joints? Now I also have a hard lump in my left wrist joint...

lemon6809, 20~29 year old female. Ask Date: 2003/08/19

Dr. Ke Zhengchang reply Internal Medicine

1.
If the swelling in your left foot has not resolved after 2 to 3 months, it is important to consider the possibility of other underlying issues, including infections or rheumatoid arthritis.
Please discuss this further with your physician.

2.
With a uric acid level of 12 and multiple swollen and painful joints, gouty arthritis is likely the most probable diagnosis; however, a definitive diagnosis should be made by your physician.
3.
Whether the swelling in your left foot is due to tophi must be determined through clinical evaluation; a correct diagnosis cannot be made based solely on your description.
4.
Tophi most commonly deposit near the joints of the left foot, but they can also occur in other tissues, including the skin and tendons.

Reply Date: 2003/08/19

More Info

Gout is a type of inflammatory arthritis characterized by the accumulation of uric acid crystals in the joints, leading to painful swelling and inflammation. Given your history of elevated uric acid levels (12 mg/dL and 9 mg/dL) and the symptoms you've described, it is quite possible that you are experiencing gout. The fact that you have had episodes of swelling in different joints, such as your right hand and now your left foot, aligns with the typical pattern of gout attacks, which can shift from one joint to another.

The swelling in your left foot that has persisted for 2-3 months could indeed be related to gout, particularly if it is accompanied by pain during flare-ups. Gout can cause chronic joint swelling and discomfort, and over time, it can lead to the formation of tophi, which are deposits of uric acid crystals that can appear as hard lumps under the skin. These tophi can develop in various locations, not just in the joints, and may be present in areas such as the ears, elbows, and even the wrists, as you mentioned with the hard lump in your left wrist.

In terms of joint aspiration, this procedure is often performed to analyze the synovial fluid in the joint space. It can help determine the presence of gout by checking for uric acid crystals under a polarized light microscope. If the aspiration was unsuccessful, it might be due to the joint being too swollen or the fluid being too viscous. If you continue to experience swelling and pain, it may be worth discussing with your healthcare provider the possibility of repeating the aspiration or considering other imaging studies, such as ultrasound or MRI, to assess the joint more thoroughly.

Regarding your question about whether gouty tophi can accumulate in areas other than the joints, the answer is yes. While tophi are most commonly found around joints, they can also form in soft tissues and other areas of the body. The presence of a hard lump in your wrist could potentially be a tophus, especially given your history of elevated uric acid levels. It is important to have this evaluated by a healthcare professional who can assess the lump and determine if it is indeed a tophus or something else.

In summary, based on your symptoms and history, it is plausible that you are experiencing gout. The persistent swelling in your left foot and the hard lump in your wrist warrant further evaluation. Managing gout typically involves lifestyle changes, such as dietary modifications to reduce purine intake (found in red meats, seafood, and alcohol), maintaining hydration, and possibly medications to lower uric acid levels. It is crucial to work closely with your healthcare provider to develop a comprehensive management plan tailored to your needs. Regular monitoring of uric acid levels and joint health will be essential in preventing future gout attacks and complications.

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