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Note that serum uric acid may be normal during an acute attack and should be rechecked after the flare resolves Joint aspiration fluid is drawn from the affected joint to examine for urate crystals under polarised microscopy and to exclude septic arthritis Imaging plain X-rays detect joint damage in chronic gout, while ultrasound or Dual Energy CT (DECT) scans can identify crystal deposition in joints and soft tissues even between attacks An accurate diagnosis is essential because other conditions, including septic arthritis and pseudogout, can produce similar common symptoms of inflammation and joint swelling

In recent years there is an appreciation of the advantages of involving patients in healthcare decisions, in contrast to the traditional paternalistic approach to medicine

Additionally, B12 works closely with folate (vitamin B9) in DNA and RNA synthesis, essential for the growth and function of all cells in the body

[9] [10] Common side effects include nausea, vomiting, diarrhea, and constipationwhich can be particularly problematic in post-surgical patients who already have altered gastrointestinal anatomy and function