Gout

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 9 Apr 2025

Last updated: 17 Nov 2022

Gout is characterized by acute onset of severe joint pain, with swelling, effusion, warmth, erythema, and or tenderness of the involved joint(s).

Arthrocentesis with synovial fluid analysis shows strongly negative birefringent needle-shaped crystals under polarized light.

Nonsteroidal anti-inflammatory drugs, colchicine, corticosteroids, or interleukin-1 inhibitors are used to treat acute disease.

Uric acid-lowering drugs (e.g., allopurinol, febuxostat, or probenecid) may be used when long-term prevention of crystal deposition is indicated.

Complications include joint destruction, kidney disease, and urolithiasis.

Definition

Gout is a syndrome characterized by: hyperuricemia and deposition of urate crystals causing attacks of acute inflammatory arthritis; tophi around the joints and possible joint destruction; renal glomerular, tubular, and interstitial disease; and uric acid urolithiasis.

The disease most commonly affects the first toe (podagra), foot, ankle, knee, fingers, wrist, and elbow; however, it can affect any joint.

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History and exam

Key diagnostic factors

men ages >40 years
use of gout-inducing medication
consumption of meat, seafood, or alcohol
history of medical condition with high cell turnover rate
rapid-onset severe pain
joint stiffness
foot joint distribution
few affected joints
swelling and joint effusion
tenderness
tophi

Full details

Other diagnostic factors

erythema and warmth
family history of gout

Full details

Risk factors

older age
male sex
menopausal status
consumption of meat, seafood, alcohol
use of diuretics
use of cyclosporine or tacrolimus
use of pyrazinamide
use of aspirin
genetic susceptibility
high cell turnover rate
obesity
adiposity and insulin resistance
exogenous insulin
hypertension
renal insufficiency
diabetes mellitus
hyperlipidemia
family history of gout

Full details

Diagnostic tests

1st tests to order

arthrocentesis with synovial fluid analysis

Full details

Tests to consider

serum uric acid level
ultrasound
dual energy computed tomography (DECT)
x-ray of affected joint

Full details

Treatment algorithm

ACUTE

acute gout

ONGOING

recurrent gout: 2-3 weeks post acute episode

Contributors

Authors

Fadi Badlissi, MD, MSc

Assistant Professor

Harvard Medical School

Attending Physician

Director of the Musculoskeletal Medicine Unit

Department of Orthopedics & Division of Rheumatology

Beth Israel Deaconess Medical Center

Boston

Disclosures

FB has received an honorarium as an advisory board member for Horizon Pharmaceuticals.

Peer reviewers

H. Ralph Schumacher, Jr., MD

Professor of Medicine

VA Medical Center

Philadelphia

Disclosures

HRS has been a consultant for a number of pharmaceutical companies that produce drugs that can be used for the treatment of gout. Some companies have supplied HRS with funding. HRS is an author of a number of references cited in this topic.

Ade Adebajo, MD

Associate Director of Teaching and Honorary Senior Lecturer in Rheumatology

Academic Rheumatology Group

Faculty of Medicine

University of Sheffield

Sheffield

Disclosures

AA declares that he has no competing interests.

Martin Underwood, MBBS

Professor of Primary Care Research

Warwick Medical School

Coventry

Disclosures

MU declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

National Institute for Health and Care Excellence. Gout: diagnosis and management. June 2022. [internet publication].Full text

FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care Res (Hoboken). 2020 Jun;72(6):744-60. Abstract

Qaseem A, Harris RP, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Management of acute and recurrent gout: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017 Jan 3;166(1):58-68.Full text Abstract

Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017 Jan;76(1):29-42.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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Gout

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

acute gout

recurrent gout: 2-3 weeks post acute episode

Contributors

Authors

Fadi Badlissi, MD, MSc

Disclosures

Peer reviewers

H. Ralph Schumacher, Jr., MD

Disclosures

Ade Adebajo, MD

Disclosures

Martin Underwood, MBBS

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Videos

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice