Gout: Features

Key points

• Gout is a form of inflammatory arthritis; patients typically have episodes lasting several days when their gout flares, and are often symptom-free between episodes
• Pain is often very significant, with associated erythema and swelling
• Around 70% of first presentations affect the 1st metatarsophalangeal (MTP) joint — historically called podagra; the ankle, foot, and knee are other commonly affected joints
• If untreated, repeated acute episodes can damage the joints, leading to chronic joint problems
• Radiological features: joint effusion is an early sign; well-defined 'punched-out' erosions with sclerotic margins in a periarticular distribution; relative preservation of joint space until late disease; eccentric erosions
• Unlike rheumatoid arthritis, there is no periarticular osteopenia in gout