acute gout

Last reviewed 07/2021

Acute gout:

  • attacks usually start in the early morning
    • often involves only a single joint but oligo-articular and polyarticular gout can occur especially in elderly patients, common sites include:
      • metatarsophalangeal (MTP) joint of the big toe (75%)
      • ankle joint
      • finger joints
      • olecranon bursae
    • these attacks are characterised by
      • severe pain (‘worst ever’) and tenderness in joints
        • pain reaches a peak within just 6–24 h of onset and then resolve spontaneously (within several days to 2 weeks) - this is almost pathognomonic of crystal synovitis
        • often the patients are unable to wear socks or touch bedsheets during flare-ups due to severe pain (2)
      • swollen and hot joints
      • overlying skin is red and shiny (3)
  • attacks are often spontaneous but may be triggered by direct trauma to a joint, intercurrent illnesses, operation, alcohol, or unaccustomed exercise
  • during the attack fever, nausea and mood swings may be present.
  • there can be skin desquamation over the inflamed area (2)

Further attacks are seen after a variable period of time. These attacks may

  • increase in severity and frequency
  • involve different joint sites
  • become oligo- or polyarticular (3)

In rare instances, monosodium urate may be deposited in the conjunctiva and cause sore eyes.


  • he patient will usually have a chronically elevated uric acid level however, during an acute attack of gout the uric acid concentrations may fall