Last reviewed: 1 Feb 2021
Last updated: 15 Feb 2021



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

Other diagnostic factors

  • erythema and warmth
  • family history of gout

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

Diagnostic investigations

1st investigations to order

  • arthrocentesis with synovial fluid analysis

Investigations to consider

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

Treatment algorithm


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 reviewersVIEW ALL

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.

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.

Professor of Primary Care Research

Warwick Medical School




MU declares that he has no competing interests.

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