A 52-year-old man with symptoms of swollen, hot and painful feet and blood uric acid of 490 μmol/L may have gout, but it may also be caused by rheumatoid arthritis, tenosynovitis and other diseases. 1. Gout: blood uric acid 490μmol / L is higher than the upper limit of the normal reference range of uric acid in men, the middle-aged patients with swollen, hot, painful symptoms in the feet should first be considered as gout may be, need to further clarify the patient’s joints or bursa whether the presence of urate crystals or whether to meet the other diagnostic criteria for gout can be a clear diagnosis. 2. Rheumatoid arthritis: blood uric acid 490μmol / L accompanied by foot swelling, heat, pain symptoms of patients also have rheumatoid arthritis may be, need to further improve the rheumatoid factor, blood sedimentation, CRP and other ancillary tests can be excluded from the diagnosis. 3. Tenosynovitis: tenosynovitis is an acute or chronic inflammation of the tendon sheaths, which can be caused by trauma, infection, strain, etc. The common symptoms of patients are joint pressure and pain, joint mobility disorders, etc. Therefore, patients with swollen, hot and painful feet may also be caused by tenosynovitis. There may be other reasons for the swollen, hot and painful feet of a 52-year-old male patient with 490 μmol/L uric acid, so it is recommended that the patient go to the orthopedics, rheumatology and immunology departments of a regular hospital to further clarify the cause of the problem.