X-rays Help Define Gout  In this article the clinical
presentation, natural history, and diagnosis of gout are
reviewed. Gout is a disorder of uric acid metabolism. Urate
crystals are produced and deposited in the joints. The joints
respond with an inflammatory reaction. The size of the deposits
can increase until they burst through the skin.  Early diagnosis
and treatment have helped reduce the painful joints often
associated with gout in the past. Blood test for urate levels
and X-rays are the most helpful diagnostic tools. Not everyone
with high uric acid levels have signs and symptoms of gout.
Treatment is not applied until uric acid is more than nine
mg/dL.  There are four stages of gout. Each one is reviewed with
X-rays to demonstrate changes seen. The exception is
asymptomatic hyperuricemia, which does not show any differences
on X-ray.  Acute gouty arthritis is the most common stage. The
patient has one or more painful, hot, red joint(s). X-rays show
soft-tissue swelling and places where the bone has