From the Research
Gout most commonly affects the first metatarsophalangeal joint, which is involved in about 50% of first gout attacks, and also frequently affects other peripheral joints including the ankles, knees, midfoot, heels, wrists, fingers, and elbows. This condition, known as podagra, is often the initial presentation of gout 1. The disease tends to target distal, cooler joints where uric acid crystals can more easily precipitate and form deposits. Gout typically presents as monoarticular arthritis (affecting a single joint) in its early stages, but can progress to involve multiple joints simultaneously as the disease becomes chronic.
The predilection for the first metatarsophalangeal joint is thought to be related to several factors including lower temperature in the extremities, trauma from walking, and the unique anatomy of this joint that may promote crystal deposition 2. Patients with suspected gout should be evaluated promptly as early treatment can help prevent joint damage and chronic disease progression. The symptoms and signs of gout result from acute and chronic inflammatory responses of the body to urate crystal deposits, and although any joint may be affected, the metatarsophalangeal (MTP) joint of the great toe (podagra) is the first joint affected in half of all cases 3.
Key points to consider in the management of gout include:
- The first metatarsophalangeal joint is the most commonly affected joint in gout
- Other peripheral joints can also be affected, including the ankles, knees, midfoot, heels, wrists, fingers, and elbows
- Gout typically presents as monoarticular arthritis in its early stages, but can progress to involve multiple joints simultaneously as the disease becomes chronic
- Early treatment is essential to prevent joint damage and chronic disease progression
- The diagnosis of gout is confirmed by the presence of characteristic monosodium urate crystals in the joint fluid, which appear needle-like and show strong negative birefringence by polarized microscopy 1.