What is the initial testing that should be performed after a physical assessment? After the physical exam, initial testing for suspected gout should begin with a serum uric acid level. While most patients with gout have elevated serum urate (>7.5 mg/dL), levels can be normal during an acute flare in up to 15% of cases. Therefore, this test alone is not diagnostic and should be interpreted alongside clinical findings. Additional supportive labs include erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count, both of which may be elevated during an acute attack. WBC counts are typically >10,000 cells/L, though they can occasionally be much higher. Radiographic imaging of affected joints may be considered. In early disease, only soft tissue swelling may be seen. With disease progression, characteristic findings include punched-out bone erosions, overhanging edges, urate tophi, and asymmetrical joint involvement with preserved joint spaces. Tophi may also appear as dense, cloud-like structures, occasionally with calcification. Uric acid kidney stones may be present in 5-10% of patients and should also be considered in the workup (Dunphy et al., 2022)