• Ask about:
• Previous attacks:
• Which joints are (and have been) involved. Gout typically affects the first metatarsophalangeal joint (big toe) — this is the case in 70% of people at first presentation, and in 90% of people at some time during the disease.
• Rapidity of onset — severe pain with associated swelling and redness, usually reaches maximum intensity within 24 hours.
• The frequency and duration of attacks.
• Any previous drug interventions tried.
• Age of onset:
• Onset of gout in someone less than 30 years of age suggests renal disease or enzymatic disorders, is often associated with genetic causes, and may require more aggressive investigation and drug treatment.
• In older people gout is more likely to be polyarticular, the upper limb is more likely to be involved, and tophi can occur early in the disease (sometimes without previous attacks of gout), and may be found in atypical sites.
• Possible risk factors for developing gout:
• Alcohol intake.
• Dietary intake of purines, particularly from red meat and seafood.
• Use of drugs that can raise plasma urate levels, such as aspirin (low-dose), ciclosporin, cytotoxic drugs, diuretics (thiazide and loop), ethambutol, nicotinic acid, pyrazinamide, tacrolimus, lead exposure.
• Family history — 20% of people with gout have a family history [DynaMed, 2007].
• Associated comorbidity which can increase the risk of developing gout:
• Obesity, hypertension, renal impairment, diabetes mellitus, myeloproliferative disease, hyperlipidaemia (especially hypertriglyceridaemia), vascular disease, severe psoriasis, enzyme defects such as hypoxanthine guanine phosphoribosyltransferase (HGPRT) deficiency and glucose-6-phosphate dehydrogenase (G6PD) deficiency.

[Cohen and Emmerson, 1998; Nuki, 2002; Terkeltaub, 2003; Dutch College of General Practitioners, 2004; Schlesinger and Schumacher, 2004; DynaMed, 2007]