GPAtlas🧭 When to suspect
Gout is the most common inflammatory arthritis.
• Suspect it when a patient presents with rapid-onset (often overnight) severe pain, redness, warmth and swelling in a single joint.
• The classic site is the first metatarsophalangeal (MTP) joint of the big toe (podagra).
• Gout is caused by deposition of monosodium urate (MSU) crystals in and around joints, driven by long-standing hyperuricaemia.
Four things matter in primary care:
• Confirm the diagnosis (clinically and with serum urate)
• Treat the flare
• Never miss septic arthritis
• Recognise that gout is a chronic, treatable crystal-deposition disease – most patients ultimately need lifelong urate-lowering therapy (ULT), not just painkillers for attacks
| Points towards gout |
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• Rapid onset peaking within 24 hours; first MTP joint (podagra), or midfoot, ankle or knee |
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• Self-limiting episodes (3–10 days) with symptom-free intervals; visible tophi |
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• Risk factors: older age, male sex, diuretics, alcohol (especially beer/spirits), obesity, chronic kidney disease (CKD), family history |
| Think again – consider an alternative |
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• Single hot, swollen joint with fever or systemic upset → septic arthritis until proven otherwise (refer immediately; the two can co-exist) |
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• Knee or wrist with chondrocalcinosis on X-ray → calcium pyrophosphate deposition (pseudogout) |
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• Symmetrical small-joint polyarthritis lasting weeks → inflammatory arthritis (e.g. rheumatoid) |
Source: NICE NG219
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