Gout is a monoarthropathy caused by deposition of monosodium urate crystals in hyperuricaemia. 

Hyperuricaemia risk factors

  • Male gender
  • Chronic kidney disease
  • Diuretics
  • Purine rich diet: alcohol, meat, seafood
  • Obesity

Clinical features

  • Tender, inflamed joint
    • Usually a monoarthritis
    • Commonly affects first metatarsophalangeal joint
    • Other joints include ankles, knees, wrists, finger joints
    • Arthralgia worse at night
  • Acute episodes last around 2 weeks 
  • Other features of hyperuricaemia
    • Gouty tophi
    • Renal nephrolithiasis


  • Bloods: uric acid level (hyperuricaemia seen in gout, but uric acid level may be falsely low or normal during attack)
  • Needle aspiration of synovial fluid – gold standard 
    • Send for polarising microscopy 
    • Send for microbiology: to rule out septic arthritis
  • X-Ray


  • Treat cause
    • Lifestyle: keep hydrated, avoid purine rich food/drink, avoid fasting, lose weight
    • Medication review: thiazides and loop diuretics can trigger gout
  • Acute management: NSAIDs, colchicine or corticosteroids
  • Prevention with urate-lowering therapies: consider starting allopurinol or febuxostat if multiple flares, gouty tophi or arthritis, CKD, or on diuretics (NB: starting urate-lowering therapy can trigger an acute episode of gout so wait 2-4 weeks after an acute flare and offer colchicine cover for first 1-3 months)

Reference: NICE ‘NG219 Gout: diagnosis and management’ 2022


What are the classical features of gout on an X-ray?

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What is pseudogout?

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What are the findings of gout and pseudogout on polarising microscopy?

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