- 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
- (1) Doherty M. New insights into the epidemiology of gout. Rheumatology (Oxford). 2009;48 Suppl 2:ii2-ii8.
- (2) Eggebeen AT. Gout: an update. Am Fam Physician. 2007;76(6):801-8.
- (3) Roddy E. Revisiting the pathogenesis of podagra: why does gout target the foot? J Foot Ankle Res. 2011;4(1):13.
Last reviewed 07/2021