Gout is often recognizable from its pattern, but no single blood test can prove every case. Diagnosis combines symptoms, examination and serum urate, with joint-fluid testing or imaging when the diagnosis is uncertain. A normal uric acid result during an acute flare does not automatically rule gout out; see Can You Have Gout With Normal Uric Acid?. If the overall picture is unclear, our Gout or Something Else? guide explains several important look-alikes.
History and examination
Clinicians look for rapid onset of severe pain, redness and swelling, especially in the big-toe joint, ankle, midfoot or knee. They also ask about previous attacks, family history, kidney disease, medicines and other risk factors.
Serum urate
A serum urate level of 6 mg/dL (360 micromol/L) or above supports a clinical diagnosis in someone with typical symptoms. But urate can fall during an acute flare, so a lower result does not rule gout out. NICE recommends repeating the measurement after the flare settles when suspicion remains high.
Joint-fluid microscopy
Finding needle-shaped monosodium urate crystals in fluid aspirated from the affected joint is the most definitive way to confirm gout. Aspiration is particularly valuable when the diagnosis is uncertain, when pseudogout is a possibility, or when a joint infection must be ruled out.
Imaging
Ultrasound and dual-energy CT can identify features of urate deposition. X-rays may show damage in longstanding gout but can be normal early in the disease.
Why infection must be considered
Septic arthritis can resemble gout and can be dangerous if treatment is delayed. A very painful red swollen joint, especially with fever or systemic illness, may require urgent assessment and joint-fluid testing.
Different countries, same diagnostic principles
NICE, the American College of Rheumatology, Australian patient resources and Kenyan clinical guidance all use the same core tools: clinical assessment, serum urate and crystal identification when needed. Exact referral and testing pathways vary by health system.
This article is educational and is not a substitute for medical care.
Sources
Related guide
If you are monitoring urate between appointments, see How Can I Check My Uric Acid at Home? Home Tests & Meters.
Evidence checked September 2026.