Where does gout typically occur?

From the Guidelines

Gout typically occurs in the joints, most commonly affecting the big toe joint (first metatarsophalangeal joint), which accounts for about 50% of first gout attacks. Other frequently affected joints include the ankles, knees, elbows, wrists, and finger joints. Gout develops when uric acid crystals accumulate in these joints, causing inflammation, intense pain, redness, and swelling. The condition tends to affect one joint at a time, especially during initial attacks, though multiple joints can become involved in later or more severe cases. The predilection for the big toe is partly due to lower body temperature in extremities, which facilitates uric acid crystal formation, and the mechanical stress this joint experiences during walking. Additionally, gout can occasionally manifest in soft tissues as tophi (nodular deposits of uric acid crystals) in advanced cases, appearing around joints, earlobes, or other areas. Understanding these typical locations helps in early recognition and prompt treatment of gout attacks.

Some key points to consider when evaluating the location of gout attacks include:

• The big toe joint is the most commonly affected joint, accounting for about 50% of first gout attacks 1
• Other frequently affected joints include the ankles, knees, elbows, wrists, and finger joints 1
• Gout can occasionally manifest in soft tissues as tophi (nodular deposits of uric acid crystals) in advanced cases 1
• The condition tends to affect one joint at a time, especially during initial attacks, though multiple joints can become involved in later or more severe cases 1

It's worth noting that the management of gout includes both pharmacologic and nonpharmacologic approaches, with a focus on urate-lowering strategies and anti-inflammatory drugs 1. However, the primary consideration when evaluating the location of gout attacks is the identification of the affected joint or joints, in order to provide prompt and effective treatment.

From the FDA Drug Label

Gout is a metabolic disorder which is characterized by hyperuricemia and resultant deposition of monosodium urate in the tissues, particularly the joints and kidneys. The FDA drug label indicates that gout typically occurs in the joints and kidneys due to the deposition of monosodium urate in these tissues 2.

From the Research

Locations Affected by Gout

• Gout typically occurs in the joints, with the metatarsophalangeal (MTP) joint of the great toe (podagra) being the first joint affected in half of all cases 3
• Any joint may be affected, but gout is characterized by reduced renal clearance or, less frequently, an overproduction of uric acid, leading to urate crystal formation and deposition, particularly in and around joints and in other soft tissue structures 3
• Gout can also cause urinary tract stones and interstitial urate nephropathy in about 20% of patients 3

Common Areas Affected

• Joints, particularly the MTP joint of the great toe 3
• Soft tissue structures 3
• Urinary tract 3
• Bursae, with swelling, pain, or tenderness in a peripheral joint or bursa, including the development of a tophus 4

Factors Influencing Gout Location

• Hyperuricemia, which predisposes to urate crystal formation and deposition, particularly in and around joints and in other soft tissue structures 3
• Reduced renal clearance or overproduction of uric acid 3
• Lifestyle factors, such as diet and alcohol intake 4