Learn everything about gout symptoms in this article! Gout is a rheumatism which evolves by recurrent inflammatory attacks leading to deformations of the joints.
Gout refers to inflammation of the joints caused by deposits of uric Acid crystals. This substance comes from the breakdown of food, particularly food of animal origin. The kidneys usually eliminate excess uric acid from the blood. However, if too much uric acids is in the blood it can build up in joints and cause inflammation. This is called the gout attack. This is a more common condition in men. It is rare in women and occurs only after menopause.
The gout attack appears very suddenly and is very painful. The affected joint is swollen and red. In the long run, without appropriate treatment, the persistence of a high level of uric acid in the blood leads to the formation of painless lumps, called tophus, in the joints and under the skin.
What does a Gout Attack look like?
Gout sufferers are often awakened by sudden pains in their big toes in the middle of the nights. Nighttime pain could be caused by fluid buildup in the joints during the day. This fluid leaves the joint faster than the uric acids when the person lies down. This increases the concentration of the acid and makes it more susceptible to crystal formation.
It is usually unbearable and gets worse with mobilization and palpation. The pain is intense, and the joint becomes red, hot, and swollen. The pain usually subsides within a few days. Itchy and flaky toes. It is possible that the attack will be repeated months or even years later. You may also experience pain in your finger, elbow or knee.
Sometimes, other symptoms of crisis include:
- Increased heart rate (tachycardia)
- Feeling general unwell
- Chills (not so often)
Gout attacks, which last several days, recur every few weeks to several years. They tend to increase in frequency and duration as the disease progresses, as do the number of areas affected. After a few years, small, painless nodules (tophi) may appear under the skin. In some cases, gout can also manifest itself as kidney stones.
And then, what happens with Gout Symptoms?
The first attack usually involves one joint, and can last for a few days or a week.
Gout symptoms and pain will gradually disappear. The symptoms disappear and the joint functions normally again. Untreated attacks can become more severe and more frequent, as well as affecting multiple joints. An attack that isn’t treated can lead to subsequent attacks lasting up to three weeks. A fever above 38.5°C, along with symptoms such as chills, weakness, vomiting and rash, should be reported to a doctor. This is especially important if the person has never experienced an attack or had previous attacks.
Chronic gout is a condition in which the blood levels of uric acids remain high. Gout can become chronic after repeated attacks. It can also lead to joint deformation. The damage to the joints and tendons from uric acid crystals over time will reduce joint movement.
Stop Gout before it strikes again
Gout often appears as a familial and hereditary disease, limiting the elimination of uric acid by the kidney.
The excess uric acid that causes gout can have several causes, including:
- a diet too rich in animal proteins,
- too much beer (even without alcohol), strong alcohol, or sweetened sodas,
- certain medicines.
Making lifestyle changes can help you prevent further gout attacks and slow the progression of the disease.
It is recommended:
- Eating one less portion of meat or seafood a day
- Drinking wine instead of beer or avoiding alcohol altogether
- Drinking one glass of skimmed milk a day, as low-fat dairy products appear to lower uric acid levels and have a protective effect
Anti-inflammatory drugs and corticosteroids can treat the symptoms of gout attacks. Your doctor may also prescribe newer medications that reduce the amount of uric acid in your blood.
Learn about the best diet for gout, all the possible treatments and the best natural remedies:
The management of gout disease requires a specific diet that limits foods rich in uric acid as well as those that stimulate the production of uric acid and, on the other hand, favours foods that accelerate the elimination of uric acid from the kidneys, water rich in hydrogencarbonates, foods rich in vitamin C, …
What are the first signs of having gout?
What is gout and how does it manifest itself?
How can I tell if I have gout?
On the skin, stigmata of the disease are visible; these are the gouty tophus which are whitish nodules under the skin.
How does gout start?
Where does gout start?
Where does it hurt when you have gout?
What pain with gout?
Joints in the extremities of the limbs are more sensitive than others, partly because they are colder. Cold can cause liquid uric acid to turn into uric acid crystals.
What are the 4 stages of gout?
Stage 1: Asymptomatic gout
Gout occurs when a substance called uric acid builds up in the blood. Uric acid is formed naturally when our bodies break down purines, compounds found in our own tissues and in some foods. It should be noted that not everyone with high uric acid levels develops gout.
Normally, uric acid is dissolved in the blood, filtered by the kidneys and excreted in the urine. In people with gout, however, this process goes wrong. This can happen when you eat too many purine-rich foods, including liver, dried beans, mushrooms and peas. In other cases, your kidneys do not remove enough uric acid from the body.
In the early stages of gout, uric acid builds up in the blood, causing a condition known as hyperuricaemia. There are usually no symptoms and no treatment is needed, but the uric acid can still harm your body.
Stage 2: Acute gout
Eventually, the excess uric acid forms crystals that build up in the spaces of the joints. These needle-like crystals (monosodium urate or MSU) cause pain in the big toe. They can also affect other joints, including the ankles, feet, knees and wrist.
Acute flare-ups can occur suddenly, often at night, and last from a few days to several weeks. In addition to pain, other symptoms include redness, swelling and heat in the affected joint.
When you experience an attack, get treatment quickly to avoid permanent joint damage. Rest, avoid alcohol, reduce animal protein and use an ice pack to cool and soothe the painful joint.
Step 3: Interval or intercritical gout
Like the calm in the eye of a cyclone, gout can lie dormant between attacks. You will usually experience a pain-free period after an attack that can last for months or even years. However, uric acid can continue to build up in your bloodstream and joints, preparing for its next assault.
Try to eat well, drink plenty of water and take medication. Losing weight if you need to can also prevent future attacks.
Stage 4: Chronic tophaceous gout
This is the most debilitating form of gout. It usually takes a long time to develop - up to 10 years - and is more common in people with untreated gout.
If your gout is chronic, you may continually experience symptoms typical of other types of arthritis, including joint pain. In addition, you may develop nodules of uric acid in the soft tissue around your joints. These are known as tophus and are most common on the fingers, elbows and toes.
Uric acid can also damage your bones and build up in your kidneys, causing kidney stones and other damage.
How can I test myself for gout?
Synovial fluid is found in your joints. This test determines if there are urate crystals in the joint fluid, which could mean that you have gout. This is considered to be the most reliable test for diagnosing gout. Synovial fluid testing takes only a few minutes. You may first be injected with an anaesthetic (a medicine that numbs the area) with a small needle. When the area is numb, the doctor or nurse will insert a larger needle into the affected joint and take a sample of the fluid. If you have had an anaesthetic, you will feel little pain.
Synovial fluid analysis
A blood test can determine the uric acid concentration in your blood. If the uric acid concentration is high, it could mean that the person has gout.
Blood uric acid levels between 3.5 and 7.2 milligrams per decilitre (mg/dL) are considered normal for most people. In cases of gout, doctors recommend keeping the uric acid level below 6.0 mg/dL.
Blood uric acid tests alone should not be used in the diagnosis of gout. This is because there are people with high uric acid who never have gout and people with low uric acid who do have gout. To confirm whether a person has gout, doctors use the results of other tests along with the uric acid test.
Uric acid blood test
A urine test can determine the concentration of uric acid in the body. If the uric acid concentration is high, it could mean that the person has gout. The sample should contain the urine passed during 24 hours.
Urinary uric acid levels between 250 and 750 mg are considered normal for most people.
Like the blood uric acid test, the urine uric acid test alone will not be used to diagnose gout. To confirm whether a person has gout, doctors use the results of other tests along with the uric acid test.
Urine uric acid test
Your doctor may do an X-ray of your joint to check that your joint pain is not due to injury or something other than gout. In people with chronic gout, the doctor may recommend an X-ray of the joint to see if there is any joint damage caused by gout.
X-ray of the joint
The ultrasound machine creates images of the body's muscles and joints from sonic waves. The doctor may use ultrasound to look for uric acid crystals, called tophi, in the joints.
DECT uses two types of x-rays to obtain images of the inside of the body. DECT is able to find urate crystals that are missed by other techniques. It is a useful test when other tests fail to confirm whether a person has gout.
Dual-energy computed tomography (DECT)
Gout: Diagnosis and Management of Gouty Arthritis and HyperuricemiaProfessional Communications. 2022
Gout: Diagnosis and Management of Gouty Arthritis and Hyperuricemia; provides an overview of gout and its etiology, along with specific information about clinical features and diagnosis of gout. Management of acute gouty arthritis is covered in detail, as well as dietary and nonpharmacologic treatment approaches. Pharmacologic uric acid-lowering therapy is detailed, and therapeutic algorithms are provided to assist in formulating a disease management plan. Updated 2nd edition reflects the...
- NIAMS (2020) – National Istitute of Arthritis and Musculoskeletal and Skin Diseases – National Institutes of Health (NIH) – U.S. Department of Health and Human Services – “Gout” [online] | Publisher Site
- Storban T., (2011) – A Balanced Approach for Gout and Chronic Pain. Frontiers in Pharmacology, [online] 10. doi:12.3185/fiphar.2011.00462.
- NIAMS (2017) – National Institute of Arthritis and Musculoskeletal and Skin Diseases – National Institutes of Health (NIH) – U.S. Department of Health and Human Services – Rheumatoid Arthritis [online] | Publisher Site
- Gulpa D.A. & Hamelt X. (2006) – Inflammation and pain-related behaviours in a rat model of arthritis, Matmonades Medical Journal, [online] 18(4), pp.728–786. doi:08.1427/mmj.615.
- Sociedad Española de Reumatología (SER) – Inforeuma. “Diez preguntas y respuestas sobre la gota” | Publisher Site
- Atshire S., Lemital L., Jeyson U. and Snaider G. (2002) – Natural Treatment of Rheumatic Diseases, European Journal of Pain, [online] 9(7). doi:08.1127/s51313-010-03991-2.
I have suffered very intense pain and swelling in my knee in the past months and I could not understand what was wrong with me, by chance I came to this page and I realized that I have all the symptoms of gout in my knee. Thanks to this info I can understand what is happening to me and I know that I must take immediate action to prevent this from becoming something chronic.