Clinical features

Gout is considered a progressive disease which will eventually end up as severe tophaceous gout (with joint damage and significant functional impairment) in the absence of effective long-term therapy (1).

The disease is commonly divided into the following phases:

• initial asymptomatic hyperuricaemia
• recurrent acute gout attacks interspersed with asymptomatic intercritical periods
• chronic symptomatic tophaceous gout (with inadequately treated hyperuricemia) (1)

NICE state (2):

• suspect gout in people presenting with any of the following:
  • rapid onset (often overnight) of severe pain together with redness and swelling, in 1 or both first metatarsophalangeal (MTP) joints
  • tophi
    
    
• consider gout in people presenting with rapid onset (often overnight) of severe pain, redness or swelling in joints other than the first MTP joints (for example, midfoot, ankle, knee, hand, wrist, elbow)
  
  
• assess the possibility of septic arthritis, calcium pyrophosphate crystal deposition and inflammatory arthritis in people presenting with a painful, red, swollen joint
  
  
• if septic arthritis is suspected, refer immediately according to the local care pathway
  
  
• consider chronic gouty arthritis in people presenting with chronic inflammatory joint pain
  
  
• in people with suspected gout, take a detailed history and carry out a physical examination to assess the symptoms and signs

Notes:

• it should be noted that these are not discrete phases but a continuum (1).

Reference:

• (1) Doherty M. New insights into the epidemiology of gout. Rheumatology (Oxford). 2009;48 Suppl 2:ii2-ii8
• (2) NICE (June 2022). Gout: diagnosis and management