Gout arthritis is characterized by which of the following features? EXCEPT DIP pain.

• A. MTP synovitis
• B. Leg oedema
• C. Ankle-synovitis
• D. DIP pain

Answer: (D)

Gout arthritis classically presents as an acute inflammatory attack in a single joint, most often the first metatarsophalangeal joint (podagra), due to monosodium urate crystal deposition triggering a vigorous neutrophilic inflammatory response. This pattern explains why MTP synovitis is a hallmark finding, and why ankle involvement can also occur during flares. Leg edema can accompany inflammatory joint swelling during an attack. Distal interphalangeal joint involvement, causing DIP pain, is not typical for gout; the DIP joints are usually spared and pain there points more toward other conditions like osteoarthritis. Therefore, DIP pain is the feature that does not fit gout.