Can Gout Cause Fever?
Yes, gout can be associated with fever, though fever is not a typical feature of uncomplicated acute gout and should prompt immediate evaluation for coexistent septic arthritis, which can occur in the same joint as gout. 1
Fever in Acute Gout: Key Clinical Considerations
When Fever Suggests Uncomplicated Gout
- Acute gout attacks characteristically present with rapid onset of severe pain reaching maximum intensity within 6-12 hours, often accompanied by joint erythema and swelling. 2, 3
- Low-grade fever may occasionally occur as part of the systemic inflammatory response to monosodium urate crystal deposition, particularly in severe polyarticular attacks. 4
- In a case series of spinal gout, fever was documented as a presenting feature alongside severe back pain, demonstrating that fever can occur in atypical gout presentations. 5
Critical Warning: Fever Mandates Exclusion of Septic Arthritis
The presence of fever in a patient with suspected gout requires immediate joint aspiration with Gram stain and culture, because gout and septic arthritis can coexist in the same joint. 1
- Among 30 reported cases of coexistent septic arthritis and gout, all patients fulfilled criteria for acute gout, yet 73% had positive synovial fluid cultures for bacterial organisms. 1
- Two patients in this series died and one required above-knee amputation, highlighting the severe morbidity and mortality risk when infection is missed. 1
- Synovial fluid culture has 76% sensitivity for detecting septic arthritis, with 96% specificity and a likelihood ratio of 18.61 for distinguishing infection from gout. 1
Diagnostic Algorithm When Fever Is Present
Step 1: Perform immediate joint aspiration with synovial fluid analysis for both monosodium urate crystals AND Gram stain with culture—even if MSU crystals are identified, infection must still be ruled out. 1, 2
Step 2: The identification of MSU crystals (needle-shaped, negatively birefringent under polarized microscopy) confirms gout with 84% sensitivity and 100% specificity, but does NOT exclude coexistent infection. 1, 2
Step 3: If joint aspiration cannot be performed safely and septic arthritis cannot be clinically excluded, empiric antibiotic coverage must be initiated while arranging urgent aspiration or surgical consultation. 1
Common Pitfalls to Avoid
- Never assume fever is simply part of a gout flare without excluding infection—the clinical presentations of septic arthritis and gout overlap significantly, and imaging findings are often nonspecific. 1, 5
- Do not rely on the presence of MSU crystals alone to rule out infection—4% of patients with documented septic arthritis also had coexistent gout (tophi) in one study. 1
- Spinal gout can mimic vertebral osteomyelitis with fever and back pain, making biopsy necessary for definitive diagnosis in atypical presentations. 5