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For typical presentations of gout, a clinical diagnosis alone is reasonably accurate (mean score of 95%), but not definitive without crystal confirmation.1 Definitive diagnosis is polarized light microscopy into clinical practice, providing urate crystal identification (negatively birefringent needle-shaped crystals) in synovial fluid.3 Overall, normal to low serum urate values have been noted in 12% to 43% of patients with acute episodes of gout

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