Can gout cause fever?

Can Gout Cause Fever?

Yes, gout can cause fever, particularly during acute gout attacks when monosodium urate (MSU) crystal deposition triggers an intense inflammatory response that can lead to systemic symptoms including fever. 1, 2

Pathophysiology of Fever in Gout

• MSU crystals directly stimulate the NLRP3 inflammasome in leukocytes, triggering an acute inflammatory cascade 2, 3
• This inflammatory response can manifest with:
  • Intense joint pain
  • Swelling
  • Erythema
  • Limited joint mobility
  • Systemic symptoms including fever

Clinical Presentation of Gout with Fever

• Acute gout attacks typically present with:

  • Rapid development of severe pain
  • Swelling and tenderness reaching maximum intensity within 6-12 hours
  • Overlying erythema
  • Fever (especially in severe attacks) 1

• The American College of Physicians recognizes that gout can present with systemic symptoms, including fever, particularly in severe or polyarticular attacks 1

• Fever is more commonly seen in:

  • Polyarticular gout attacks
  • Attacks with intense inflammation
  • Patients with tophi (chronic deposits of MSU crystals)

Diagnostic Considerations

• When fever is present with joint symptoms, it's important to consider:

  • Gout with systemic inflammatory response
  • Concurrent septic arthritis (can coexist with gout) 1
  • Other inflammatory arthritides

• The gold standard for diagnosis remains identification of MSU crystals in synovial fluid 1

• Important clinical pearl: Gout and sepsis may coexist in the same joint, so when septic arthritis is suspected, Gram stain and culture of synovial fluid should still be performed even if MSU crystals are identified 1

Management Implications

• The presence of fever does not change the first-line treatment options for acute gout:

  • NSAIDs (e.g., indomethacin) 4
  • Colchicine (low-dose regimens preferred)
  • Corticosteroids (oral or intra-articular) 1

• Systemic symptoms including fever typically resolve with appropriate anti-inflammatory treatment

• In cases with high fever or systemic symptoms suggesting infection, additional workup may be warranted

Allopurinol Hypersensitivity Syndrome

• A rare but serious adverse reaction to allopurinol that can present with fever
• Often associated with rash, eosinophilia, and multi-system organ damage 1, 5
• Has a high mortality rate
• More common in patients with renal insufficiency and certain ethnic groups
• Not to be confused with fever from acute gout itself

Clinical Pearls

• Fever in gout is typically moderate and resolves with treatment of the acute attack
• Persistent high fever or other signs of infection should prompt evaluation for concurrent septic arthritis
• The rapid onset of symptoms (reaching maximum within 6-12 hours) with overlying erythema is highly suggestive of crystal-induced inflammation like gout 1
• Gout should be considered in the differential diagnosis of acute monoarthritis with fever, especially in patients with risk factors for hyperuricemia

In conclusion, fever is a recognized systemic manifestation of acute gout attacks, resulting from the intense inflammatory response triggered by MSU crystal deposition. While not present in all cases, fever can be part of the clinical presentation, particularly in severe or polyarticular attacks.