From the Guidelines
Gout most commonly affects the first metatarsophalangeal joint (the big toe joint), which is involved in about 50% of first gout attacks, as well as other lower extremity joints including the midfoot, ankle, and knee, and less commonly, upper extremity joints such as wrists, fingers, and elbows. This condition, known as podagra, is often the initial presentation of gout 1. The disease typically begins as monoarticular (affecting a single joint) but can progress to polyarticular involvement in chronic cases. Joints with pre-existing damage or osteoarthritis are more susceptible to gout attacks due to decreased urate solubility in damaged cartilage.
Some key points to consider when evaluating the joints affected by gout include:
- The big toe joint is the most commonly affected joint, involved in about 50% of first gout attacks 1
- Other lower extremity joints, such as the midfoot, ankle, and knee, are also frequently affected
- Upper extremity joints, such as wrists, fingers, and elbows, can be affected, though less commonly
- Joints with pre-existing damage or osteoarthritis are more susceptible to gout attacks
- Gout tends to target peripheral joints, particularly those with lower body temperature which facilitates urate crystal formation 1
During an acute attack, the affected joint becomes intensely painful, red, swollen, and warm to touch—classic signs of inflammation resulting from the immune system's response to urate crystal deposition in the joint space. The management of gout includes both pharmacologic and nonpharmacologic approaches, with pharmacologic therapies focusing on urate-lowering strategies and anti-inflammatory drugs 1.
From the Research
Joints Affected by Gout
- The metatarsophalangeal (MTP) joint of the great toe (podagra) is the first joint affected in half of all cases of gout 2
- Gout can affect any joint, but it commonly affects the foot, ankle, midtarsal, knee, wrist, finger, and elbow 3
- The interphalangeal joints of the foot can also be affected, although this is less common, occurring in about 6.8% of patients with pedal gout 4
- Other joints that can be affected by gout include the hands, wrists, elbows, and knees 5
Characteristics of Gout
- Gout is characterized by the deposition of monosodium urate crystals in the joints and soft tissues, leading to arthritic changes 3, 5
- Hyperuricemia is the hallmark of gout, and it can lead to the formation of urate crystal deposits in and around joints and other soft tissue structures 2
- Gout can cause severe pain, reducing quality of life for patients with this condition 6