**Core Concept**
In acute gout, urate crystals deposit in the joints, triggering an inflammatory response. This condition is characterized by sudden, severe pain, swelling, and redness in the affected joint. The involvement of joints in gout is primarily influenced by the deposition of monosodium urate crystals.

**Why the Correct Answer is Right**
Acute gout typically affects joints with a high frequency of urate crystal deposition, such as the metatarsophalangeal joint of the big toe (podagra), knees, ankles, wrists, and elbows. This is due to the presence of synovial fluid, which allows for the accumulation of urate crystals. The involvement of these joints is a result of the inflammatory response triggered by the deposition of urate crystals, leading to the characteristic symptoms of gout.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is a distractor, as the joints mentioned are commonly involved in acute gout. The metacarpophalangeal joints of the hands are indeed involved in gout, making this option incorrect.
**Option B:** Similarly, this option is a distractor, as the wrists are also commonly affected in acute gout.
**Option C:** This option is a distractor, as the elbows are also commonly involved in gout.

**Clinical Pearl / High-Yield Fact**
In acute gout, the presence of tophi (deposits of monosodium urate crystals) in the joints or surrounding tissues is a hallmark of chronic gout. Tophi are often associated with joint damage and can be a source of chronic inflammation.

**Correct Answer: A. Metacarpophalangeal joints of the hands.**