Gouty Arthritis, Acute

Presentation

A patient rapidly develops an intensely painful monoarticular arthritis, often in the middle of the night, but sometimes a few hours following a minor trauma. The first attack of acute gouty arthritis usually occurs between the ages of 40 and 60 years in men and after the age of 60 years in women.

Any joint may be affected, but the most common is the metatarsophalangeal joint of the great toe (podagra). Other lower limb joints, including the ankle, knee, and tarsal joints, are commonly involved. The joint is red, warm, swollen, and intensely tender to touch or movement. There is increased sensitivity of the overlying skin, and pain can be precipitated with little stimulation, such as a bed sheet touching the area. There is usually no fever, rash, or other sign of systemic illness, although low-grade fever, leukocytosis, and an elevation of the erythrocyte sedimentation rate may occur.

The patient may have predisposing factors that increase the risk for developing gout, such as obesity, moderate to heavy alcohol intake (especially beer), high blood pressure, diabetes, a family history of gout, and abnormal kidney function. Certain medications, including thiazide diuretics, low-dose aspirin, and tuberculosis medications (pyrazinamide and ethambutol), can also precipitate gout.