Gout is caused by genetic disposition and alimentary factors. It comprises a heterogeneous group of disorders characterized by deposition of monosodium urate crystals in the joints and tendons. Asymptomatic hyperuricemia is common and should not ordinarily be treated. Gout progresses through four clinical phases: asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout (intervals between acute attacks) and chronic tophaceous gout. A combination of increased production of uric acid and insufficient excretion causes the disease to become clinically evident. The causes are deposits of uric acid that can be found in the distal extremities, especially adjacent to joints, primarily in the toes but also in the fingers. The foot, heel, ankle, knee, hands, wrists and elbows are the other joints that are frequently involved (i.e. rather peripheral joints). A familial pattern is observed in up to 15% of cases. Obesity, high blood pressure and atherosclerotic heart disease are often associated.