Gout is characterized by excruciating, sudden, unexpected, burning pain, as well as swelling, redness, warmth, and stiffness in the affected joint. This occurs commonly in men in their toes but can appear in other parts of the body and affects women as well. Low-grade fever may also be present. The patient usually suffers from two sources of pain. The crystals inside the joint cause intense pain whenever the affected area is moved. The inflammation of the tissues around the joint also causes the skin to be swollen, tender and sore if it is even slightly touched. For example, a blanket or even the lightest sheet draping over the affected area could cause extreme pain.
Gout usually attacks the big toe (approximately 75 percent of first attacks); however, it also can affect other joints such as the ankle, heel, instep, knee, wrist, elbow, fingers, and spine. In some cases, the condition may appear in the joints of small toes that have become immobile due to impact injury earlier in life, causing poor blood circulation that leads to gout.
Patients with long-standing hyperuricemia (see below) can have uric acid crystal deposits called tophi (singular: tophus) in other tissues such as the helix of the ear. Elevated levels of uric acid in the urine can lead to uric acid crystals precipitating in the kidneys or bladder, forming uric acid kidney stones.
The signs and symptoms of gout are almost always acute, occurring suddenly often at night and without warning. They include :
- Intense joint pain. Gout usually affects the large joint of your big toe but it can occur in your feet, ankles, knees, hands and wrists. If untreated, the pain typically lasts five to 10 days and then stops. The discomfort subsides gradually over one to two weeks, leaving the joint apparently normal and pain-free.
- Inflammation and redness. The affected joint or joints become swollen, tender and red.
- Red and shiny skin around your joint
- Fever
- Firm, white lumps beneath the skin, called tophi (if you have had gout for some time)
The small joint at the base of the big toe is the most common site of an acute gout attack of arthritis. Other joints that can be affected include the ankles, knees, wrists, fingers, and elbows. Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. Tenderness can be intense so that even a blanket touching the skin over the affected joint can be unbearable. Patients can develop fever with the acute gout attacks. These painful attacks usually subside in hours to days, with or without medication. In rare instances, an attack can last for weeks. Most patients with gout will experience repeated attacks of arthritis over the years.
Uric-acid crystals can deposit in tiny fluid-filled sacs (bursae) around the joints. These urate crystals can incite inflammation in the bursae leading to pain and swelling around the joints, a condition called bursitis. In rare instances, gout leads to a more chronic type of joint inflammation which mimics rheumatoid arthritis.
In chronic (tophaceous) gout, nodular masses of uric acid crystals (tophi) deposit in different soft tissue areas of the body. Even though they are most commonly found as hard nodules around the fingers, at the tips of the elbows, and around the big toe, tophi nodules can appear anywhere in the body. They have been reported in unexpected areas such as in the ears, vocal cords, or (rarely) around the spinal cord!
The most common sign of gout is a nighttime attack of swelling, tenderness, redness, and sharp pain in your big toe. You can also get gout attacks in your foot, ankle, or knees. The attacks can last a few days or many weeks before the pain goes away. Another attack may not happen for months or years.
The first symptom of gouty arthritis is typically the sudden onset of a hot, red, swollen joint. The most common joint involved is at the base of the big toe, but almost any joint can be involved. In some people, the acute pain is so intense that even a bed sheet on the toe causes severe pain. Acute gouty arthritis at the base of the big toe is referred to as podagra.
Even without treatment, the first attacks stop spontaneously after one to two weeks. While the pain and swelling completely go away, gouty arthritis almost always returns in the same joint or in another joint.
With time, attacks of gouty arthritis can occur more frequently and may last longer. While the first attacks usually involve only one or two joints, multiple joints can be involved simultaneously over time.
People usually have gout for a period of up to two weeks (an attack) and then it goes away eventually, even without treatment. With treatment, this can be reduced to less than one week.
Left untreated, attacks of gout may become more frequent and last longer.
Gout usually occurs in 'attacks'. An attack typically develops quickly over a few hours. It usually causes severe pain in one joint. The base of the big toe is the most commonly affected joint. Walking can be very painful and even the weight of bedclothes can hurt.
However, any joint can be affected. Sometimes two or more joints are affected. Affected joints usually swell, and the nearby skin may look red and inflamed. If left untreated, a gout attack may last several days, but usually goes completely within 7-10 days. Less severe attacks can occur which may be mistaken at first for other forms of arthritis. Weeks, months or even years may go by between attacks. Some people only ever have one attack.
See your doctor even if your pain from gout is gone. The buildup of uric acid that led to your gout attack can still harm your joints.
