Gout is an inflammatory arthritis that classically affects the first metatarsal phalangeal joint
Gout prefers cool ambient temperature hence gouty tophi prefer the great toe (one of the coldest parts of the body) and avoids "warmer" joints such as the hip and shoulder.
Remember that gout can affect other joints as well (elbow, wrist, knee and ankle) and can cause painful bursitis and tendonitis
Multiple joints can be involved simultaneously (leading to confusing with RA and OA)
The involved joint will often be red, hot, swollen and very painful leading to easy confusion with cellulitis and or a septic arthritis
Diagnose gout by demonstrating monosodium urate crystals in the synovial fluid.
**Remember previous pearl by Dr. Bond regarding the coexistence of gout with septic joint**
Serum uric acid levels are commonly elevated but can be normal or even low
Use caution with this test because asymptomatic hyperuricemia is much more common than gout
