This investigation was undertaken to define prospectively the clinical characteristics of patients with crystal-documented gouty arthritis simultaneously involving multiple joints. Of 106 consecutive patients with gouty arthritis (GA), 42 (40%) had articular inflammation at 2 or more sites. Comparison of these 42 patients with GA with the 64 patients with GA who presented with monoarthritis yielded the following conclusions: 1) Polyarticular gout represents one end of a generally predictable spectrum of GA, reflecting chronicity associated with poor patients understanding, poor patient compliance, and suboptimal physician management. 2) Polyarticular patients with GA tend to develop attacks of more smoldering onset and increasing duration, while joint involvement tends to occur in an ascending but asymmetrical fashion, with upper extremity joints later added to repeatedly active lower extremity sites. 3) There may be a significant discrepancy between the site (or sites) of the GA patient's chief complaint and clinically involved joints on careful physical examination. 4) Recognition of polyarticular joint involvement increases the number of sites for potential joint and/or tophus aspiration, permitting greater ease of establishing a definitive diagnosis. 5) No single laboratory or synovial fluid value meaningfully distinguishes patients with polyarticular from those with monoarticular gout.