Why does gout affect mostly the first metatarsophangeal joint? No one really knows for sure, but there are several possibilities:
1. The joint is further away from core body temperature than other joints, so the temperature of the joint is lower. This may affect the crystallisation of the uric acid.
2. The pH of this joint is lower and may also affect the crystallisation of uric acid
3. The first MPJ is subject to more trauma (on average) than other joint
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