Gout Symptoms Should Not Be Ignored

Paying Attention to Gout Symptoms Is Imperative

506062287.jpg
Joe_Potato/E+/Getty Images

Gout symptoms can develop when there is excess uric acid in the body. Monosodium urate crystals that form in the joints due to excess uric acid cause gout to develop. Uric acid is a waste product normally present in the blood as a result of the breakdown of purines. Purines are part of all human tissue and are found in many foods. Eating foods high in purines can raise uric acid levels in the blood and precipitate gout attacks in some people.

Excess uric acid in the blood, referred to as hyperuricemia, is caused by increased uric acid production in the body or inadequate elimination of uric acid from the body. It's important to recognize the signs and symptoms associated with gout, so that recurring gout attacks can be prevented or properly treated. About one in 100 people are affected by gout and perhaps as many as 7 percent of older men.

Recognizing Gout Symptoms

Gouty arthritis is a term used to describe painful, recurring attacks of joint inflammation. Generally, there are three stages of gout. Some medical literature counts a fourth stage as the period between gout attacks. The three stages are:

  • Asymptomatic hyperuricemia - Elevated blood uric acid occurs without symptoms of gout.
  • Acute intermittent gout - One joint becomes inflamed and painful (i.e., acute monoarthritis), typically lasting for about 2 weeks if untreated, and less if treated. Symptoms may not recur for weeks, months or years.
  • Chronic tophaceous gout - The affected joint becomes more frequently inflamed and uncomfortable. More than one joint may be affected at this stage. Crystals may collect and form tophi which are lumps underneath the skin. The development of kidney stones is also possible at this stage.

During the acute intermittent stage, the big toe is most commonly involved.

Any joint may be involved though. The affected joint typically is:

  • shiny and red
  • swollen
  • warm
  • intensely painful

Gout is more common in men than women, in postmenopausal women, and in people with kidney disease. Gout has been linked to obesity, hypertension, hyperlipidemia, and diabetes. There may be genetic factors involved since gout tends to run in families.

The Typical Gout Attack - Sudden Symptoms

  • The onset of a gout attack is usually quick. Often gout symptoms (warmth, swelling, redness, and pain) begin during the night.
  • Over an 8 to 12 hour period the pain level worsens, going from mere twinges to intense pain.
  • The big toe is affected in 90 percent of people with gout. The midfoot, ankles, heels, and knees are also fairly common sites—wrists, fingers, and elbows are less common.
  • Walking is difficult when a gout attack affects the lower extremities.
  • Fever, chills, and malaise (i.e., not feeling well) may also accompany acute gout attacks.

Why Gout Symptoms Should Not Be Disregarded

The goal of gout treatment is to minimize or prevent future gout attacks.

Early treatment, when initial gout symptoms occur, and lifestyle modifications are important measures to take. Lifestyle modifications can include losing weight, following an anti-inflammatory diet, and decreasing alcohol intake, if not avoiding it altogether. People who experience infrequent gout attacks may be tempted to ride it out and disregard the potential severity. There is no cure for gout. Symptoms must not be ignored and effort must go into managing the disease, otherwise gout attacks may become more frequent and more severe—with consequences.

In fact, acute polyarticular gout (involving more than one joint), which initially occurs in fewer than 20 percent of people with gout, may become more common when gout symptoms are untreated. In such cases, there are more frequent recurrences of gout, few to no periods that are symptom-free, and evidence of tophaceous deposits. Many people with gout think "no symptoms, no problem" but that perspective is a fallacy. Most people don't realize that even during the intermittent phase that occurs between gout attacks, there may still be tophi that are being formed and deposited, inevitably leading to bony erosions and, ultimately, chronic gout.

Sources:

Becker, Michael A., MD. Clinical Manifestations and Diagnosis of Gout. UpToDate, Updated September 19, 2016.

Schumacher, H. Ralph, MD. Gout. Fast Facts. American College of Rheumatology. April 2015.

What Is Gout? Arthritis Foundation.

Gout. Primer on the Rheumatic Diseases. Thirteenth edition. Arthritis Foundation.

Continue Reading