What is the first step to take when suspecting gout or any hot swollen joint?

When suspecting gout or any hot swollen joint, the first step in management is to perform a joint aspiration. This procedure is crucial because it allows for synovial fluid to be obtained and analyzed, which can help confirm the diagnosis. In cases of gout, looking for monosodium urate crystals in the synovial fluid is the definitive way to identify an acute attack.

Further, aspiration can provide immediate relief by reducing the intra-articular pressure and may also help in diagnosing other potential causes of the joint swelling, such as infection or other types of arthritis. While starting NSAIDs, colchicine therapy, or requesting imaging studies like an X-ray may be part of the management process, they should be considered after joint aspiration to ensure an accurate diagnosis is made and to rule out other conditions that could mimic gout.