Polyarticular joint pain and swelling. Is it gout?
Polyarticular initial attacks occur in roughly 3-14% of patients.
Bilateral gout is uncommon at presentation.
However, this presentation is more frequent with longstanding , poorly controlled disease.
Additional Information
Common initial presentation is textbook: monoarticular, classically the first MTP (podagra) or may involve a single lower limb joint.
Over time recurrent flares become:
- Longer lasting
- Polyarticular
- Affect upper-limb joints (wrist, elbow for example)
As gout becomes longstanding (~15 years), urate crystal deposition at a given joint was most strongly associated with symmetric involvement of the SAME joint on the contralateral side
OR 26.1 in hands/wrists, 46.9 in feet/ankles, 9.9 in knees
Erosive lesions in the feet/ankles were also highly symmetric (OR 91.4)
Take home:
- Consider acute gout as a lower limb monoarticular disease.
- Conceptualize chronic gout as a bilateral/symmetric polyarthropathy
- An initial presentation of an acute symmetric polyarthritis should prompt consideration of alternative diagnoses (CPPD or rheumatoid arthritis for example).
References
Yokose C, Dalbeth N, Wei J, Nicolaou S, Simeone FJ, Baumgartner S, Fung M, Zhang Y, Choi HK. Radiologic evidence of symmetric and polyarticular monosodium urate crystal deposition in gout - A cluster pattern analysis of dual-energy CT. Semin Arthritis Rheum. 2020 Feb;50(1):54-58.