podagra

Podagra is a gout attack that involves the joints of the foot, most commonly the first metatarsophalangeal joint (the big toe). The term has historically referred to gout affecting the foot and reflects the frequent site of early attacks. Gout is a form of inflammatory arthritis caused by the deposition of monosodium urate crystals in joints and soft tissues when serum urate levels are chronically elevated (hyperuricemia). It can result from overproduction or, more often, underexcretion of uric acid by the kidneys.

Risk factors include male sex, increasing age, obesity, and conditions such as hypertension, renal impairment, and metabolic syndrome. Diet and lifestyle factors that raise urate levels—high purine intake (certain meats and seafood), beer and alcohol use, dehydration—can contribute. Initiation of urate-lowering therapy is often considered in people with recurrent attacks or tophaceous disease, and care should be taken to treat acute attacks promptly while planning long-term urate control.

Clinical features typically include a sudden, severe, hot, swollen, and very painful big toe joint, often waking the patient at night. Attacks may last days to weeks and then remit, with possible intercritical periods. Diagnosis rests on clinical presentation supported by laboratory and microscopic findings: synovial fluid analysis shows needle-shaped monosodium urate crystals that are negatively birefringent under polarized light; serum urate may be elevated, though normal values do not exclude an acute attack. Imaging can show joint damage in chronic gout.

Management aims at treating acute flares, preventing recurrence, and lowering serum urate to under 6 mg/dL (360 µmol/L). Acute therapy includes NSAIDs, colchicine, or corticosteroids. Long-term treatment may involve urate-lowering therapy (allopurinol, febuxostat, or probenecid), lifestyle modification, and management of comorbidities. Differential diagnoses include pseudogout and septic arthritis.