The purpose of this study was to determine the characteristics of gouty arthritis in an urban Guatemalan population. We reviewed the medical records of 148 (145 males and 3 females) patients with a diagnosis of acute gouty attack seen at an urban rheumatology clinic in Guatemala City between 1982 and 1993. Mean age at diagnosis was 49 years (range 21-87), mean age of onset was 42 years, mean duration of disease 7.4 years, family history of gout 42 (28%), peak prevalence 5th decade 39 (26%). Seventy-one (48%) had monarticular, 49 (33%) oligoarticular, and 22 (15%) polyarticular attacks, respectively. Podagra was seen in 34 (23%) patients; however, 108 (73%) developed it at any moment of their life. Tophaceous gout was seen in 33 (22%). Mean serum urate concentrations (enzymatic method) were higher than 7.0 mg % in 90 (60%) patients. At follow-up, 44 (30%) patients never returned to our clinic, and a large majority of them [66 (45%)] were seen only during acute attacks. Associated disorders included hypertension (43%), obesity (27%), nephrolithiasis (16%), ischaemic heart disease (7%), renal insufficiency (2%), stroke (0.6%), and diabetes mellitus (0.6%), and two died due to sepsis; high alcoholic intake was found in 58 (39%) patients. In conclusion, our findings indicate that gout is not an unusual disorder in the Guatemalan population. It presents with the same characteristics as those reported in Caucasians, with the possible exception of a lower frequency of diabetes mellitus as an associated disorder.