Signs and symptoms of Gout

Gout flares usually strike suddenly, at night, and without any warning. Gout can present in a number of ways, although the most usual is a recurrent attack of acute inflammatory arthritis. During the attack, the affected area becomes hot, red, swollen, and extremely joint. Having gout may sometimes feel like your toe is a volcano erupting into a hot, fiery flare. The metatarsal-phalangeal joint at the base of the big toe is affected most often, accounting for half of cases. Other joints, such as the heels, knees, wrists and fingers, may also be affected. Joint pain usually begins over 2–4 hours.The reason for onset at night is due to the lower body temperature then. Other symptoms may rarely occur along with the joint pain, including fatigue and a high fever.

Gout Progression

Gout can have a long-term impact—including effects that continue between attacks. In fact, joint damage may occur even between attacks if uric acid levels in your blood are high. Tophi—deposits of uric acid crystals—may form in the joints of the hands and feet as well as the ear, the elbow, and the Achilles tendon. Additional long-term consequences may include chronic pain that doesn't go away between attacks, damage to your joints, and increasingly limited mobility in the affected joints and tendons.

Gout is a chronic, progressive disease, which means it may get worse over time.

Gout may be best known for causing severe pain in the toe. While most gout attacks do occur in the big toe, they can occur in other parts of the body as well. One survey of people with gout showed the percentages of where gout attacks occurred in the body:

- Big toe (76%)
- Ankle or foot (50%)
- Knee (32%)
- Finger (25%)
- Elbow (10%)
- More than one site (11%)
- Wrist (10%)

If you have gout, you may be surprised to learn that it can attack silently, even between flares. You may not feel it, but gout's root cause—high uric acid—can allow crystals to continuously form and build up in your joints. Over time, this may lead to attacks in other joints, constant pain, and joint destruction. So don't wait. Talk with your doctor about ways to keep your uric acid at a lower, healthy level.

Long-standing elevated uric acid levels (hyperuricemia) may result in other symptomatology, including hard, painless deposits of uric acid crystals known as tophi. Extensive tophi may lead to chronic arthritis due to bone erosion. Elevated levels of uric acid may also lead to crystals precipitating in the kidneys, resulting in stone formation and subsequent urate nephropathy.

The 4 Stages of Gout

Stage 1: High uric acid levels without symptoms
High Uric Acid Level

During the first stage, you have high uric acid levels. But because you have never experienced a gout flare, you do not yet have gout. Your healthcare professional may refer to this stage as "asymptomatic hyperuricemia." Most people with high uric acid levels don't actually develop gout. Those who do develop gout may have high uric acid levels for more than 20 years before they experience their first gout attack. Currently, there are not any recommendations for treating high uric acid before you have had your first gout attack. If you have high uric acid levels, talk to your doctor about what this might mean for you.

Stage 2: Gout Attacks
High Uric Acid Level

During a gout attack—your healthcare professional may refer to this as "acute gout"—excess uric acid begins to form crystals, causing inflammation in your joints that leads to the swelling and pain of a gout flare. These gout flares usually strike suddenly, at night, and without any warning. During the attack, the area becomes hot, red, swollen, and extremely tender. People describe gout in many painful ways—they say it's like a blow torch, a jackhammer, or walking barefoot on a bed of hot coals. And, unfortunately, once you have one gout attack, you're likely to have another.

For most people with gout—78% in fact—a second gout attack occurs within 6 months to 2 years of their first attack. Later attacks are more likely to involve more than one joint at a time. Attacks initially begin with less severity, eventually becoming more severe, lasting longer, with recovery taking longer than during initial gout attacks. And, gout attacks can become more common.

Talk to your healthcare professional if you're suffering from gout flares as he/she may prescribe medications or recommend over-the-counter treatments to address the pain and inflammation of your gout attacks. It's important to remember, though, that treating pain and inflammation doesn't address the underlying cause of gout, high uric acid. To help manage your gout over the long term, it is important to keep your uric acid level below 6 mg/dL. So, make an appointment with your doctor to discuss ways you may be able to achieve and maintain lower, healthy uric acid levels. To get the most from your appointment, use our Gout Conversation Card.

Stage 3: Between Gout Attacks
High Uric Acid Level

The time between gout attacks, when you're not experiencing the painful symptoms of gout, is something your healthcare professional may refer to as "intercritical gout." It's important to remember that even when you aren't experiencing painful flares, you still have gout. In fact, research suggests that the uric acid crystals that cause painful gout flares are still present in the joints for as long as you have high uric acid. So, joint damage may still continue even between gout flares.

A uric acid level below 6 mg/dL is the recommended target level for the long-term management of gout. Decreasing your uric acid level reduces your risk of future gout attacks. And there are options that may help you get there.

See how uric acid crystals are still present in the body, even when you are not experiencing a flare.

Stage 4: Chronic Gout
High Uric Acid Level

Gout's final phase, referred to by healthcare professionals as "chronic tophaceous gout," is the most disabling phase of the disease. Over time, the period between gout attacks may disappear, leaving behind constant joint inflammation, joint deformity, and deposits of crystallized uric acid (tophi). Tophi can cause chronic and persistent pain, joint destruction, damage surrounding tissues, and may also lead to deformities.

And you can still have painful gout attacks even during this uncomfortable period!