A 55-year-old man presents with sudden, severe pain in the first MTP joint after drinking red wine. What is the likely diagnosis?

The presentation of sudden, severe pain in the first metatarsophalangeal (MTP) joint, especially after drinking red wine, is highly indicative of gout. Gout is caused by the deposition of monosodium urate crystals in the joints due to hyperuricemia, which can be precipitated by certain dietary factors, including purine-rich foods and alcoholic beverages, particularly red wine.

The acute attack typically features severe pain, swelling, and erythema in the affected joint. The first MTP joint, often referred to as the "podagra" joint, is the most commonly affected site during initial gout attacks. The sudden onset and the link to recent dietary choices, such as alcohol consumption, align perfectly with this condition.

In other conditions like osteoarthritis, joint pain tends to develop gradually and is often worsened with activity rather than triggered by dietary indiscretion. Pseudogout can present similarly but is caused by calcium pyrophosphate crystals, and the pain and swelling typically occur less acutely. Septic arthritis would usually present with fever, systemic symptoms, and often occurs in a patient who is ill, along with joint effusion.

Thus, given the specific context of sudden and severe pain following the consumption of red