Gout typically presents as which pattern?

• A. Monoarticular joint pain with involvement of the first metatarsophalangeal joint
• B. Symmetric polyarthritis of the hands
• C. Diffuse back pain
• D. Knee effusions with fever only

Answer: (A)

Gout presents as an abrupt, severe inflammatory arthritis that usually affects a single joint—monoarticular inflammation. The classic pattern is the big toe’s first metatarsophalangeal joint involvement (podagra). This occurs because monosodium urate crystals deposit in peripheral joints, triggering a rapid neutrophil-driven inflammatory response in one joint at a time.

This monoarticular, podagra pattern helps distinguish gout from other conditions. Symmetric polyarthritis of the hands is typical of rheumatoid arthritis, not gout. Diffuse back pain isn’t the characteristic presentation of an acute inflammatory arthropathy. Knee effusion with fever could suggest septic arthritis or another issue rather than the typical gout flare.

So the best choice is the single swollen, painful joint with involvement of the first MTP joint.