We aspirated synovial fluid from the knees of 50 patients with asymptomatic, nontophaceous gout, in whom synovial fluid monosodium urate (MSU) crystals had previously been documented in the knees or other joints. Fifty-eight percent of these asymptomatic patients had MSU crystals in their knee joints. Serum uric acid levels, serum creatinine levels, volume of synovial fluid aspirated, and cell counts of the aspirated fluid did not differentiate the MSU crystal-positive group from the group without MSU crystals. Clinical factors such as alcohol abuse, coronary heart disease, hypertension, duration of gout, duration of the intercritical period, and drug therapy did not differentiate the 2 groups. Nineteen patients consented to aspiration of their other knee. Seven of these patients (37%) had MSU crystals bilaterally, and 6 patients (32 %) had them unilaterally. The implications of the persistence of MSU crystals (including those in intracellular locations) in many patients, despite normalization of serum uric acid levels, should be determined. Knee joint aspiration is a sensitive method for the demonstration of MSU crystals in asymptomatic patients. The procedure might also be useful in documenting these crystals in patients who have had attacks of arthritis with features consistent with a diagnosis of gout, but in whom MSU crystals have not been documented.Patients with suspected diagnoses of nontophaceous gout, in whom synovial fluid has not been examined for the presence of monosodium urate (MSU) crystals, are often seen by rheumatologists. Most of the rheumatologists consider that a firm diagnosis of gout can be made only by identifying MSU crystals in the synovial fluid of such patients.Previously, MSU crystals have been documented by examination of synovial fluid from both the symptomatic and the asymptomatic first metatarsophalangeal (MTP) joints of patients with nontophaceous gout (1-3). Knee joints are easier to aspirate than are MTP joints, and one would expect that more synovial fluid could be obtained for examination while maintaining the sensitivity of MTP joint aspiration. In one study (4), the synovial fluid from the knees of patients with asymptomatic, clinically tophaceous gout was aspirated, and MSU crystals were documented in 11 of the 13 patients (85%).We attempted to aspirate synovial fluid from the knees of 51 asymptomatic patients with nontophaceous gout, in whom synovial fluid urate crystals had previously been documented in at least 1 joint (not necessarily the knee). We found that 58% of these asymptomatic patients had MSU crystals in their knee joints, and such factors as alcohol abuse, coronary heart disease, and serum uric acid levels did not
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