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Quick history:
Rhematologist confirmed my gout about 8 months ago based on symptoms, uric acid, and response to gout meds. ?The only lingering pain i have now (from what started as a few months of being bedridden) is pain and swelling in my L knee. ?My knee pain/limp/swelling has varied over the past 8 months…..but has never been back to the point where i could ever go for a jog (which i used to do regularly prior to 8 months ago).
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He sent me to an orthapedic surgery to scope the l knee to see if something else was irritating it. ?Prior to doing surgery, the Orthapedic wanted to draw fluid during swelling to confirm or deny that gout was causing this particular swelling. ?I just came from his office where he aspirated some joint fluid.
?His recommendation is that:
1) if he finds support for gout in the fluid, then he recommends no surgery
2) if no support for gout in fluid…then surgery.
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My questions to the group:
1) Has anyone had a negative fluid aspiration, who eventually confirmed they had gout,
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2) can they detect crystals if blood is aspirated along with the fluid (he got about 10 cc of yellow fluid prior to the fluid getting contaminated with about 40 cc of blood and fluid). ?he mentioned he got more blood then he wanted to in the sample.
3) any negative impact with the joint after the aspiration for anyone. ?I asked him not to inject cortizone, and althogh i felt immediate relief from the aspiration, ive got some throbbing now
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4) does it matter “when” the fluid is aspirated. ?I started treating the attack with indo, which started to take the swelling down, then i went to see him while the swelling was subsiding.?
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Thanks in advance
JP
1. Best way to determine gout is by detecting UA crystals in the fluid.
2. But on very rare cases crystals are not present or detected and still it is gout. This was my case.
3. I think I have had three aspirations on my left knee and two on my right. No problem in any of them.
4. I had a knee arthroscopy ?and surgeon found all my joint was full with UA crystals; was the final diagnose that I really had gout. He cleaned and removed damaged tissue and for now, one year later, I am perfect thanks to surgery and alopurinol.?
5. Surgeon told me if UA level could not be control then I must return every 5 years to “clean” my knee.
The best moment for aspirating is during an attack.?
All I can add to esabogal's excellent points, is beware of poor testing procedures. In all the studies I've seen, rheumatologists come way ahead in the competence stakes for joint aspiration. Even then, there have been some significant failings if fluid is not analyzed under appropriate microscope almost immediately. Crystals will dissolve after being drawn, so always make sure fluid will be tested immediately when you consent to the test.
One more thing,
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I just had an appointment with the Rheumatoligist. I told him that the ortho aspirated some fluid to see if he could detect gout in my knee. ?The Rheumatologist said that since my UA is at 4 while on 300 of ap, that crystals will never show upon aspiration.?
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Does that make sense to anyone??
I was under the impression that a gout attack will show crystals, regardless of what your ua is. ?IE someone on 300 of ap who has a gout attack will still show crystals.?
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JP
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