Gout Symptoms

The signs and symptoms of gout almost always occur suddenly, and often at night. 

Gout symptoms 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 (8 to 10 out of 10).
  • 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.
  • 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, flares may continue to be a recurrent problem but the intervals between flares become painful on a daily basis. 

Adequate treatment with appropriate uric acid-lowering therapies early on in the course of gout should prevent or eliminate gout flares, tophus formation, and bony erosions from occurring.

What Joints Can Gout Affect?

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. 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 high uric acid in the blood, or hyperuricemia, will at some time 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 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, flares may continue to be a recurrent problem but the intervals between flares have now become painful on a daily basis. Adequate treatment with appropriate uric acid-lowering therapies early on in the course of gout should prevent or eliminate all three of the gout manifestations from occurring.

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