Gout - What Happens
develops after a number of years of buildup of
uric acid crystals in the joints and surrounding
tissues. A gout attack usually starts during the night with moderate pain that
grows worse. A gout attack typically causes pain, swelling, redness, and warmth
(inflammation) in a single joint, most often the big
toe (this symptom is called podagra), followed by the eventual disappearance of
- Most gout attacks stop after about a week.
- Mild attacks may stop after several hours or
last for 1 to 2 days. These attacks are often misdiagnosed as "tendinitis" or "sprain" even
though there was no trauma or overuse.
- Severe attacks may last up
to several weeks, with soreness lasting for up to 1 month.
people have a second attack of gout within 6 months to 2 years after their
first attack, but there may be intervals of many years between attacks. If
untreated, the frequency of attacks usually increases with time.
There are three stages of gout.1 Many people never experience the third stage.
First stage: High blood uric levels
- The uric acid level in the blood may be higher
than normal, but there are no symptoms of gout.
- High uric acid in
the blood (hyperuricemia) may never progress beyond this stage, and symptoms of
gout may never develop.
- Some people may have kidney stones before
having their first attack of gout.
Second stage: Episodes of acute gouty arthritis separated by periods without symptoms
- This stage is also called intercritical or interval gout.
- Uric acid crystals begin to form in the joint
fluid, usually in one joint-most commonly the big toe-and the body often
responds with a sudden inflammatory reaction: a gout attack.
- Although the big toe is the most common site for a gout attack,
gout may develop in other joints, including the knee, ankle, and joints in the
foot, wrist, and fingers.
- After the gout attack is over, the
affected joint and surrounding tissues feel normal within days until the next
attack, which often occurs within 2 years.
- For many
people this period becomes progressively shorter as attacks occur more often.
Later attacks may be more severe, last longer, and involve more than one
Third stage: Chronic tophaceous gout
- If gout symptoms have occurred off and on
without treatment for several years, they may become ongoing (chronic) and
frequently affect more than one joint. There may no longer be periods of time
between attacks. This stage of gout is frequently confused with other forms of
arthritis, most commonly
- By this time, enough uric
acid crystals have accumulated in the body to form gritty nodules called
tophi. When located just under the surface of the
skin, these deposits are usually firm and movable. The overlying skin may be
thin and red. Tophi that are very near the skin may appear cream-colored or
- At first, tophi are usually found on or near the elbow,
over the fingers and toes, or on the outer edge of the ear.
- If the
condition progresses without treatment, tophi may form in the
cartilage of the external ear or the tissues around
the joint (bursae,
tendons), resulting in pain, swelling, redness, and
warmth (inflammation). Progressive crippling and destruction of cartilage and
bone is possible.
- This stage of gout is uncommon because of
advances in the early treatment of gout.