What issues you should cover

Confirm diagnosis—Is it really gout? A typical history of rapid onset, severe, self limiting joint pain reaching its maximum over 6-12 hours, with swelling and erythema, suggests gout, particularly if it involves the first metatarsophalangeal joint at some point. (This joint is affected in 90% of cases and is the first joint affected in 70%.) The presence of tophi support the diagnosis. Previous evidence of monosodium urate crystals from a joint aspirate (during or between attacks) would be the gold standard. A concentration of serum uric acid (SUA) of ≤380 µmol/l at least one month after an acute attack or ≤330 µmol/l during an attack makes gout an unlikely diagnosis.

Causes—Look for risk factors (see box).

Complications—These might include renal stones, nephropathy, or tophi.

Consider—Associated metabolic syndrome may be present.