Can gout cause fever and chills?

Can Gout Cause Fever and Chills?

Yes, gout can cause fever and chills, though these are not typical symptoms of uncomplicated gout and should prompt immediate evaluation for concurrent septic arthritis or severe polyarticular disease. 1

Clinical Significance of Systemic Symptoms in Gout

While gout classically presents with acute joint pain, swelling, and erythema that reaches maximum intensity within 6-12 hours, the presence of fever and chills warrants heightened clinical concern 2:

• Fever and chills are NOT listed among the typical symptoms of uncomplicated gout by EULAR or ACR guidelines, making their presence a red flag 1
• Septic arthritis can coexist with gout, and the presence of fever and chills should trigger immediate consideration of concurrent bacterial infection 2, 1
• The ACR specifically recommends considering septic arthritis in patients with gout who present with fever and chills 1

Immediate Diagnostic Approach

When a patient with suspected or known gout presents with fever and chills, you must:

• Perform arthrocentesis immediately to obtain synovial fluid for both crystal analysis AND Gram stain/culture 2
• Send blood cultures before initiating any antibiotics 2
• Recognize that gout and sepsis may coexist - finding monosodium urate crystals does NOT exclude infection 2
• Check complete blood count with differential, looking specifically for leukocytosis that may suggest infection 2

Critical pitfall: Do not assume systemic symptoms are solely from gout without ruling out infection, as delayed antibiotic therapy in septic arthritis significantly increases mortality 2

When Fever/Chills May Be Gout-Related

Severe polyarticular gout flares can occasionally present with systemic symptoms 1:

• More aggressive anti-inflammatory therapy may be needed for gout presenting with systemic symptoms including chills 1
• Consider systemic corticosteroids for severe polyarticular flares in patients with gout and chills 1
• One case report documented severe systemic inflammatory response syndrome (SIRS) with fever, disorientation, polyarthritis, and acute kidney injury immediately following spinal surgery in a patient with axial gout 3

Treatment Algorithm Based on Clinical Presentation

If infection is suspected (fever >101°F, rigors, hemodynamic instability, or high clinical suspicion):

• Obtain cultures immediately (synovial fluid, blood) 2
• Initiate empirical antibiotics as soon as cultures are obtained - do not delay 2, 1
• In patients with cirrhosis or septic shock, mortality increases 10% for every hour's delay in antibiotics 2

If severe gout flare without infection (crystals confirmed, cultures negative):

• Use systemic corticosteroids (oral or parenteral) for severe polyarticular disease 1
• NSAIDs, colchicine, or corticosteroids remain first-line for acute attacks 2
• Indomethacin is effective for acute gouty arthritis and has been shown to reduce pain, fever, swelling, redness, and tenderness 4

Additional Considerations

• Patients with gout have higher rates of comorbidities (cardiovascular disease, chronic kidney disease) that may independently cause fever and chills 1
• The presence of chills should prompt assessment for other conditions beyond gout and infection 1
• Typical gout symptoms may be absent or atypical in patients with multiple comorbidities 2

Bottom line: Fever and chills in a patient with gout represent either severe polyarticular disease requiring aggressive anti-inflammatory therapy OR concurrent infection requiring immediate antibiotics. When in doubt, treat for both until infection is definitively excluded by negative cultures.