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.
There are three manifestations of gout used to classify the severity of gout.
Gout flares, tophus formation and bony erosions, and chronic persistent arthritis.
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.