Can gout cause chills?

Chills in Gout: Clinical Manifestations and Significance

Chills are not a typical symptom of uncomplicated gout, but they may occur in cases of severe gouty arthritis or when gout is accompanied by infection or systemic inflammation.

Clinical Presentation of Gout

• Gout typically presents as an acute, extremely painful arthritis most commonly affecting the first metatarsophalangeal joint (podagra), but can involve other joints as well 1
• The cardinal symptoms of acute gout include:
  • Rapid onset of severe pain and swelling that reaches maximum intensity within 6-12 hours 2
  • Joint erythema (redness) 2
  • Tenderness of the affected joint 1
  • Limited range of motion due to pain 1

When Chills May Occur in Gout

• Chills are not listed among the typical symptoms of uncomplicated gout in any of the major guidelines, including those from the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) 2
• However, chills may occur in the following gout-related scenarios:
  • Severe polyarticular gout flares that trigger a significant systemic inflammatory response 3
  • Gout complicated by septic arthritis (a medical emergency requiring immediate attention) 2
  • Advanced tophaceous gout with extensive crystal deposition and chronic inflammation 2

Diagnostic Considerations

• The definitive diagnosis of gout requires identification of monosodium urate (MSU) crystals in synovial fluid or tophus aspirates 2
• When a patient with suspected gout presents with chills, clinicians should:
  • Consider the possibility of concurrent infection, particularly septic arthritis 2
  • Perform arthrocentesis to examine synovial fluid for both MSU crystals and evidence of infection 2
  • Evaluate for other systemic causes of chills, including infection elsewhere in the body 2

Clinical Significance and Management

• The presence of chills in a patient with gout should prompt consideration of:
  • More aggressive anti-inflammatory therapy for severe gout flares 3
  • Evaluation for possible infection, including blood cultures and synovial fluid analysis when appropriate 2
  • Assessment for other comorbidities that may contribute to systemic symptoms 2

Treatment Considerations

• For uncomplicated gout without systemic symptoms like chills:
  • NSAIDs, colchicine, or corticosteroids are appropriate first-line treatments 3
• For gout with systemic symptoms including chills:
  • More aggressive anti-inflammatory therapy may be needed 3
  • Consider systemic corticosteroids for severe polyarticular flares 2
  • If infection is suspected, appropriate antibiotics should be initiated after cultures are obtained 2

Important Caveats

• Fever with chills in a patient with acute joint pain should always raise suspicion for septic arthritis, which can coexist with gout 2
• Patients with gout have higher rates of comorbidities that may independently cause chills, including cardiovascular disease and chronic kidney disease 2
• Proper diagnosis requires careful clinical assessment and, when possible, crystal identification through joint aspiration 2

In summary, while chills are not a typical feature of uncomplicated gout, their presence should prompt evaluation for more severe disease, concurrent infection, or other comorbidities that may require specific management approaches.