From the Research
The most common joint affected in gout is the first metatarsophalangeal joint, which is involved in about 50% of first gout attacks, as noted in a study published in the American Family Physician in 2014 1. This classic presentation is known as podagra. After the big toe, gout commonly affects other lower extremity joints including the midfoot, ankle, and knee. Upper extremity joints such as wrists, fingers, and elbows can also be affected, though less frequently. Gout tends to target peripheral and cooler joints first because urate crystals form more readily at lower temperatures. The disease typically begins as monoarticular (affecting a single joint) but can progress to polyarticular involvement in chronic cases. Some key points to consider when evaluating the affected joints in gout include:
- Joint selection in gout relates to several factors including temperature, trauma, and pre-existing joint damage.
- Synovial fluid in affected joints contains needle-shaped monosodium urate crystals that trigger the inflammatory cascade responsible for the intense pain, redness, and swelling characteristic of acute gout attacks.
- Understanding which joints are commonly affected helps clinicians make accurate diagnoses and develop appropriate treatment plans for patients with suspected gout, as supported by a review of treatments for acute gout published in The Cochrane Database of Systematic Reviews in 2021 2. It's also worth noting that while other studies, such as those published in 2014 3, 2020 4, and 2014 5, provide additional information on the treatment and management of gout, the most relevant and recent evidence for determining the most common joint affected in gout is found in the study published in the American Family Physician in 2014 1.