In gout, which joint is most commonly involved in the initial attack?

In gout, which joint is most commonly involved in the initial attack?

• A. First MTP joint
• B. Knee
• C. Wrist
• D. Elbow

Answer: (A)

Gout often starts with a sudden, intensely painful attack in the first toe joint (the first metatarsophalangeal joint). This site is most commonly affected because urate crystals precipitate more readily in cooler, peripheral joints, and the big toe is especially exposed to low temperatures and mechanical stress. The acute flare is driven by crystals activating neutrophils and releasing inflammatory mediators, leading to rapid swelling, redness, and extreme pain. While gout can involve other joints such as the knee, wrist, or elbow, those are less typical at the initial presentation.

Gout often starts with a sudden, intensely painful attack in the first toe joint (the first metatarsophalangeal joint). This site is most commonly affected because urate crystals precipitate more readily in cooler, peripheral joints, and the big toe is especially exposed to low temperatures and mechanical stress. The acute flare is driven by crystals activating neutrophils and releasing inflammatory mediators, leading to rapid swelling, redness, and extreme pain. While gout can involve other joints such as the knee, wrist, or elbow, those are less typical at the initial presentation.