Is the first gout attack typically monoarticular or polyarticular?

Most people experience their first gout attack in a single joint.

Typically, it affects the joint of the big toe, medically known as the "first metatarsophalangeal joint" (MTP joint). Typical symptoms include suddenly waking up in the middle of the night due to pain, with the affected toe becoming red, swollen, and hot, and excruciatingly painful. Walking becomes impossible, and sometimes even the weight of a bedsheet is unbearable.

This is mainly because urate crystals tend to deposit in the cooler joints at the extremities of the body, making the big toe the primary target.

Of course, a small number of people experience their first attack in other joints such as the ankle, knee, or wrist. It's relatively rare for multiple joints to be affected simultaneously during the first attack, but it's not unheard of.

However, it's important to note that if gout is not well-controlled, after repeated attacks, it may no longer be limited to a single joint and could develop into polyarticular pain (multiple joints hurting simultaneously), which is much more problematic. Therefore, once you've experienced a first attack, it's crucial to take it seriously and see a doctor promptly.