40% of the male patients suffering from gouty arthritis treated in our rheumatological unit during a three years period showed a chronic polyarticular course. In polyarticular gout, acute gouty attacks affect above all the joints of the upper limbs. Gouty arthritis in these patients shows an ascending pattern. Therefore, in case of unawareness of the clinical symptoms, differential diagnosis can be difficult especially when laboratory findings including uric acid levels are in normal ranges and classical radiological findings are missing. It is important to notice that the atypical joint attack in gouty arthritis is typical for polyarticular gout. In case of unclear arthritis the polarized light microscopy of the synovial fluid should always be demanded.