Gout on the acute medical take.

Gout is the commonest form of inflammatory arthritis. Flares are the commonest presentation of gout. Typically, gout flares present as acute monoarthritis, and most often affect the first metatarsophalangeal joint ('podagra'). Other joints in the lower limbs are affected more often than those in the upper limbs. Joint aspiration followed by examination of the synovial fluid using a polarised light microscope is the gold standard for a definite diagnosis of gout. Gout may be diagnosed without recourse to joint aspiration if there is podagra, elevated serum urate and no suspicion of infection. Ultrasonography and dual energy computed tomography may be used to diagnose gout if joint aspiration is unsuccessful or not feasible. Oral colchicine, NSAIDs and glucocorticoids have similar efficacy for controlling gout flare with differing adverse effect profiles. Consequently, the drug choice depends on comorbidities and patient preference.