Investigations and Tests
At the Foot and Ankle Clinic we provide a GOLD STANDARD in analysis of synovial fluid analysis for the diagnosis of gout or pseudogout when prior attempts have provided false negatives through blood tests. The gold standard for the diagnosis of gout is identification of monosodium urate (MSU) crystals within the synovial fluid aspirated from the joints of a gout patient using a compensated polarized light microscope (CPLM).
At the Foot and Ankle Clinic we provide tests for fungus of the nails. Ask your podiatrist if this may be required.
Gout
At the Foot & Ankle Clinic, we use a gout microscope assembled specifically for identifying gout or pseudo-gout crystals suspended in synovial fluid. Gout is a kind of arthritis that occurs when uric acid builds up in blood and causes joint inflammation. Gout is generally tested through a blood test but is prone to false positives or false negatives.
The GOLD standard is diagnosed by taking synovial fluid from the infected joint in the process of arthrocentesis. A wet smear is prepared on a microscope slide with the collected fluid and viewed using the polarized microscopy to determine the presence of sodium urate crystals (gout) or calcium pyrophosphate dehydrate (CPPD)- pseudo-gout within the fluid. CPPD crystals are small rods, squares, or rhomboids and are usually harder to identify without a gout or polarized light microscope. Polarizing filters can be easily adjusted when using the gout microscope. The beam splitter sends light directly up to the camera to capture images.
At the Winnipeg Foot and Ankle Clinic, Dr. Amar Gupta has identified gout in other areas of the foot and ankle compared to the typical big toe joint when the diagnoses has been questioned.
Gout (left) vs. Pseudo Gout (right)