Where does gout usually strike?

Where Gout Usually Strikes

Gout most commonly affects the first metatarsophalangeal joint (big toe), but can also affect other joints including the ankle, knee, wrist, elbow, and finger joints. 1

Common Sites of Gout Attacks

• The first metatarsophalangeal joint (podagra) is affected in approximately 50% of initial gout attacks 2
• Other commonly affected joints include:
  • Foot joints 1
  • Ankle joints 1
  • Midtarsal joints 1
  • Knee joints 1
  • Wrist joints 1
  • Finger joints 1
  • Elbow joints 1
  • Hip and shoulder joints (less commonly) 1

Patterns of Joint Involvement

• Monoarticular involvement (single joint) is typical in early disease, particularly affecting the lower extremity joints 1
• Polyarticular gout (involving 4 or more joints) can occur, especially in later stages of the disease 1
• Gout affecting 3 separate large joints is considered a form of polyarticular gout 1

Beyond Joint Involvement

• Gout can also affect periarticular structures including:
  • Bursae (such as olecranon bursa) 3
  • Tendons 3
• Tophi (solid monosodium urate crystal deposits) can develop in:
  • Joints 3
  • Soft tissues 3
  • Helix of the ear 3
  • Over interphalangeal joints 3

Clinical Presentation

• Acute gout attacks are characterized by:
  • Rapid onset of severe pain 1
  • Swelling 1
  • Erythema (redness) over the affected joint 1
  • Maximum intensity of symptoms within 6-12 hours 1

Risk Factors for Gout

• Male sex (7.64 times higher risk) 1
• Hyperuricemia (though not diagnostic on its own) 1
• Obesity (3.81 times higher risk) 1
• Hypertension (3.93 times higher risk) 1
• Chronic renal failure (4.95 times higher risk) 1
• Diuretic use (1.72 times higher risk) 1
• Alcohol consumption, especially beer 4
• Diet high in purines (organ meats, shellfish) 1

Diagnostic Considerations

• Definitive diagnosis requires identification of monosodium urate crystals in synovial fluid or tophus aspirates 1
• Clinical diagnosis can be reasonably accurate for typical presentations (such as recurrent podagra with hyperuricemia) but is not definitive without crystal confirmation 1
• Serum uric acid levels alone cannot confirm or exclude gout, as many people with hyperuricemia do not develop gout, and levels may be normal during acute attacks 1

Clinical Course

• Gout typically progresses through several phases:
  • Asymptomatic hyperuricemia 3
  • Acute gouty arthritis (flares) 3
  • Intercritical periods (asymptomatic intervals between flares) 3
  • Chronic tophaceous gout (if untreated) 3

Understanding the typical distribution of gout attacks helps clinicians make an accurate diagnosis and initiate appropriate treatment to prevent joint damage and reduce the risk of recurrent flares.