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 – most classically the first metatarsophalangeal (MTP) joint of the big toe (podagra). It is caused by deposition of monosodium urate (MSU) crystals in and around joints, driven by long-standing hyperuricaemia.
The key skills in primary care are fourfold: confirm the diagnosis (clinically and with serum urate), treat the flare, never miss septic arthritis, and 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 | Think again – consider an alternative |
|---|---|
|
• Rapid onset peaking within 24 hours; first MTP joint (podagra), or midfoot, ankle or knee |
• Single hot, swollen joint with fever or systemic upset → septic arthritis until proven otherwise (refer immediately; the two can co-exist) |
|
• Self-limiting episodes (3–10 days) with symptom-free intervals; visible tophi |
• Knee or wrist with chondrocalcinosis on X-ray → calcium pyrophosphate deposition (pseudogout) |
|
• Risk factors: older age, male sex, diuretics, alcohol (especially beer/spirits), obesity, chronic kidney disease (CKD), family history |
• Symmetrical small-joint polyarthritis lasting weeks → inflammatory arthritis (e.g. rheumatoid) |
Source: NICE NG219
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