From the Research
During a gout flare, inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are consistently elevated, while serum uric acid levels may not always be elevated, as they can paradoxically decrease during an acute attack 1. The most recent and highest quality study, published in 2023, found that serum uric acid levels were significantly downregulated during the acute flare compared to after the flare 1. Key laboratory findings that are consistently elevated during a gout flare include:
- Inflammatory markers: CRP and ESR, which reflect the underlying inflammatory response triggered by urate crystal deposition in joints 2, 1
- White blood cell count: often increased, typically between 10,000-15,000 cells/μL, reflecting the inflammatory response 2
- Synovial fluid analysis: reveals characteristic negatively birefringent monosodium urate crystals under polarized light microscopy, along with elevated white blood cell counts in the fluid (typically 2,000-100,000 cells/μL with neutrophil predominance) 3 These laboratory findings are essential for confirming an active gout flare, especially when serum uric acid levels are not elevated. It's also important to note that environmental factors, such as increased purine consumption and medication use, can trigger gout flares 4. Overall, the diagnosis and management of gout should be based on a comprehensive approach, taking into account the patient's clinical presentation, laboratory findings, and environmental factors 3.