• Confirm gout and exclude alternative diagnoses, especially septic arthritis.
• Assess the severity of the attack (number of joints affected, the person's ability to mobilize, impact on work and functioning).
• Ask about previous attacks and which drugs (if any) the person is taking or has tried (nonsteroidal anti-inflammatory drug [NSAID] or urate-lowering drugs).
• Assess risk factors such as medication (e.g. diuretics), alcohol, diet, and obesity.
• Identify any associated conditions (e.g. hypertension, diabetes, cardiovascular disease), and arrange follow up to manage these as appropriate.
• Measure the person's serum uric acid level 4–6 weeks after the acute attack.

• The diagnosis of gout is based on clinical history and examination. The serum uric acid (SUA) level can be normal during an acute attack, especially if the person is taking urate-lowering drugs, high-dose aspirin, or corticosteroids, or drinks excessive amounts of alcohol. See Diagnosing gout for more information.
• If septic arthritis is suspected, then either refer urgently or aspirate the joint and arrange urgent microscopy and culture. See Differential diagnosis.
• Assess a person's cardiovascular risk (usually after the attack has settled). Provide lifestyle advice and manage any associated conditions. See Follow up for more information.

These recommendations are based on published expert opinion, pragmatic advice and a guideline produced by expert representatives of the British Society for Rheumatology (BSR). The evidence supporting the BSR recommendations is based on a systematic review of literature [Jordan et al, 2007].