The diagnosis can be made clinically in classic presentations. Definitive diagnosis requires arthrocentesis to confirm intracellular negatively birefringent crystals. Sometimes arthocentesis is required to rule out septic arthritis. X rays will be normal in early gout. They may be useful if rheumatooid arthritis is a consideration.
Serum uric acid levels are not useful for ED management. A normal serum uric acid does not rule out gout and, conversely, an elevated serum uric acid level does not diagnose gout.