The Most Common Symptoms of Gout Include
- Pain and swelling — usually in one or two joints in the feet or legs, most commonly the big toe. During a gout flare, the intensity of the pain is usually described as excruciating. This rating would be around eight to ten on a scale from one to ten.
- Chronic persistent arthritis — During the early stages of gout, the inflammatory arthritis is intermittent. In between flares, joints may feel and function normally. Flares may continue to be a recurring symptom of gout for years to decades after the initial flare. However, as the disease progresses, the intervals between flares shorten and those with gout may have persistent pain.
- Limited joint function — After five or more years of recurrent flares, people with gout may develop tophi crystals under the skin and around joints. While generally not painful, tophi can be disfiguring and interfere with normal joint function. The presence of tophi close to bones can lead to bone and cartilage destruction, creating further deformities in the affected joints.
Adequate treatment with appropriate uric acid-lowering therapies early on in the course of gout should prevent or eliminate gout flares, tophus formation, bony erosions, and other gout symptoms from occurring.
Read an in-depth post about gout symptoms, causes, and treatments.
Where Do Gout Signs and Symptoms Show?
Gout affects the big toe in 50 percent of all first flares. It can also affect the middle of the foot, ankle, knee, wrist, and elbow. A flare may not always occur in the same joint each time. The pain could be in the big toe during the first flare and then in the knee or other joints in later flares. Men often experience gout flares in the lower extremities, while women are more likely to experience flares in the upper extremities.
The severity of gout can be classified into three manifestations.
Gout Flares
Uric acid crystals that have formed over years or decades of hyperuricemia (high uric acid in the blood) will sometimes lead to a sudden onset of severe pain, swelling, and tenderness. This usually occurs in one or two joints in the feet or legs. The intensity of the pain is usually described as excruciating (8 to 10 out of 10). The affected joints are very tender, even to the lightest of touch.
Without treatment, these gout symptoms may last for 5-10 days, and weight-bearing is very difficult. Recurrent flares may occur in the same joint or other joints of the upper or lower extremities.
Tophus Formation and Bony Erosions
After five or more years of recurrent flares, people with gout may develop tophi under the skin and around joints. While generally not painful, tophi can be disfiguring and interfere with normal joint function. The presence of tophi close to bones can lead to bone and cartilage destruction, creating further deformities in the affected joints.
Chronic Persistent Arthritis
During the early stages of gout, the inflammatory arthritis is intermittent and during the periods between flares, joints may feel and function normally. Years to decades after the initial flare, symptoms of gout, including flares, may continue to be a recurrent problem. The intervals between flares shortens and the pain persists. Adequate treatment with appropriate uric acid-lowering therapies early on in the course of gout can prevent all three manifestations of gout from occurring.
Gout Signs and Symptoms: Frequently Asked Questions
What is gout, and what causes it?
Gout is a common form of inflammatory arthritis caused by too much uric acid in the blood, a condition called hyperuricemia. When your body produces more uric acid than the kidneys can eliminate, crystals can form in the joints, leading to pain and inflammation.
What are the symptoms of a gout flare?
A gout flare is characterized by sudden and intense pain, redness, warmth, and swelling in one or more joints—most often the big toe. The pain can be so severe that even light contact, like a bedsheet, feels unbearable.
How long do gout flares last?
In early stages, gout flares typically last between 3 to 7 days. Even though the pain subsides, uric acid levels often remain high, which can lead to future flares and joint damage if left unmanaged.
What causes high levels of uric acid?
High uric acid levels can result from genetics, obesity, certain medications (like diuretics or niacin), chronic conditions (like kidney disease, hypothyroidism, or psoriasis), and diets high in purines (found in red meat, shellfish, and alcohol).
What are uric acid crystals, and why are they a problem?
Uric acid crystals (monosodium urate) form when uric acid builds up and deposits in the joints or soft tissue. These crystals are what trigger the painful inflammation of a gout flare and, over time, can cause permanent joint damage or even kidney stones.
What is a healthy uric acid level?
A healthy blood uric acid level is generally below 6.0 mg/dL. Levels above that increase the risk of gout flares and other health issues.
How is gout diagnosed?
Doctors may diagnose gout based on your symptoms, medical history, and uric acid levels. In some cases, a joint fluid test is done to identify uric acid crystals directly, although this is less common in routine care.
Is gout the same as arthritis?
Yes, gout is a type of inflammatory arthritis. It is actually the most common form of inflammatory arthritis, more prevalent than rheumatoid or psoriatic arthritis.
What is the difference between gout and osteoarthritis?
Gout is an inflammatory arthritis caused by uric acid buildup, whereas osteoarthritis is a non-inflammatory arthritis caused by joint wear and tear over time. Gout typically presents with sudden, painful flares, while osteoarthritis symptoms build more slowly.
Why does gout usually affect the big toe first?
The big toe has a cooler internal temperature than other joints, making it a common site for uric acid crystal formation. Over 90% of people with gout will experience at least one flare in the big toe.
Can gout cause permanent joint damage?
Yes, if left untreated, repeated gout flares can lead to permanent joint damage, erosion of bone, and destruction of surrounding tissue. Over time, this can result in limited mobility and chronic pain.
How is gout treated?
Gout is treated in two ways:
- Managing flares with anti-inflammatory medications started at the first sign of symptoms
- Lowering uric acid levels using long-term medications to maintain levels below 6.0 mg/dL
It’s important not to stop uric acid-lowering therapy during a flare unless advised by your doctor.
What lifestyle changes can help manage gout?
- Drink plenty of water to support kidney function
- Limit intake of purine-rich foods like red meat, shellfish, and alcohol
- Maintain a healthy weight
- Exercise regularly
- Avoid smoking
- Manage conditions like diabetes, high blood pressure, and high cholesterol
Diets such as the Mediterranean or DASH diet are often recommended for gout management.
How often should uric acid levels be tested?
When starting uric acid-lowering treatment, blood tests may be needed frequently. Once your levels are stable and under 6.0 mg/dL, you should have them checked at least twice a year.
What are tophi and can they be harmful?
Tophi are large deposits of uric acid crystals that can form under the skin after years of untreated gout. While they may not always be painful, they can cause joint destruction, deformity, and limited mobility.
What are the risk factors for developing gout?
- Genetics or family history of gout
- Obesity
- Kidney disease
- Heart disease or high blood pressure
- Diabetes
- Certain medications
- Alcohol use
- Being male or a post-menopausal female
Gout is more common in men, particularly between ages 40–55, but postmenopausal women are also at increased risk.
Does gout increase the risk for other health problems?
Yes. Gout is linked to several other health conditions, including:
- Kidney disease
- Heart disease and increased risk of heart attack or stroke
- Type 2 diabetes
Managing uric acid levels may reduce the risk of these comorbidities.
Can gout be cured?
While gout may not be “cured” in the traditional sense, it can be effectively managed. With proper treatment, lifestyle changes, and uric acid control, many people can live free of flares and long-term damage.
Gout Cartoons
Check out this months featured gout cartoons, inked by artist Shaun Boland.
Gout Education Library
Download and order free gout resources.
Resource Survey
Find specific resources based on your unique circumstance.