Key Points on Acute Flares

  • Initial attacks of gout usually occur in the lower extremities and are typically monoarticular.
  • An acute flare at the first metatarsophalangeal (MTP) joint, known as podagra, is the most common site of an acute flare.
  • Podagra occures in 80% of patients with gout, and 50% of patients experience their first acute flare in this joint.
  • Patients may present with symptoms in alternate joints, such as the ankles, tarsal and other metatarsal joints, knees, and elbows, which should also be evaluated for gout.
  • Gout can also occur in bursae and tendons.
  • Polyarticular involvement and involvement of hands and more proximal joints are more likely as gout progresses and flares become more common.
  • Flares involving multiple joints in the upper extremities are a more common feature in early gout in women than in men. 8
  • sUA levels are often normal during a flare, so measurements should be made at least 2 weeks post flare. sUA may behave as negative reactant, being temporarily lowered during episodes of acute inflammation and stress. There may also be an increased renal excretion of uric acid during acute episodes. 9