The first gout attack is typically which stage?

• A. Acute intermittent gout
• B. Chronic tophaceous gout
• C. Intercritical gout
• D. Asymptomatic hyperuricemia

Answer: (A)

The first gout attack is an acute inflammatory arthritis. It presents as a sudden, severe, painful, red, and swollen joint—often the big toe—caused by monosodium urate crystals triggering acute inflammation. This stage is best called acute intermittent gout, emphasizing that these inflammatory episodes occur as discrete events separated by symptom-free periods. After the attack, you have an intercritical gout interval with no symptoms, before any possible future attacks. Asymptomatic hyperuricemia is when uric acid is high but there are no symptoms, and chronic tophaceous gout is a late stage with persistent symptoms and tophi. So the first attack fits the acute intermittent gout description.