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Last reviewed: 4 Sep 2023
Last updated: 17 Nov 2022



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
More key diagnostic factors

Other diagnostic factors

  • erythema and warmth
  • family history of gout
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • arthrocentesis with synovial fluid analysis
More 1st investigations to order

Investigations to consider

  • serum uric acid level
  • ultrasound
  • dual energy computed tomography (DECT)
  • x-ray of affected joint
More investigations to consider

Treatment algorithm


acute gout


recurrent gout: 2-3 weeks post acute episode



Fadi Badlissi, MD, MSc
Fadi Badlissi

Assistant Professor

Harvard Medical School

Attending Physician

Director of the Musculoskeletal Medicine Unit

Department of Orthopedics & Division of Rheumatology

Beth Israel Deaconess Medical Center




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




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




AA declares that he has no competing interests.

Martin Underwood, MBBS

Professor of Primary Care Research

Warwick Medical School




MU declares that he has no competing interests.

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