Arthritis Gout Gout Guide Gout Guide Symptoms Causes Diagnosis Treatment Diet Coping Symptoms of Gout Attacks can often worsen over time if left untreated By Carol Eustice Carol Eustice Facebook Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. Learn about our editorial process Updated on August 26, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by David Ozeri, MD Medically reviewed by David Ozeri, MD LinkedIn David Ozeri, MD, is a board-certified rheumatologist. He is based in Tel Aviv, Israel, where he does research at Sheba Medical Center. Previously, he practiced at New York-Presbyterian Hospital. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Frequent Symptoms Complications When to See a Healthcare Provider Frequently Asked Questions Next in Gout Guide Causes and Risk Factors of Gout Gout, also known as gouty arthritis, can develop when there is excess uric acid in the body. Symptoms can be sudden and severe, causing pain, redness, and swelling in the affected joint, most often the big toe. Attacks occur most frequently at night or in the early morning hours. If left untreated, recurrent attacks can lead to joint deformity and the progressive restriction of movement. While the severity of symptoms can vary, gout tends to progress in stages and worsens over time. By recognizing and treating the symptoms early, you can avoid many of the long-term complications and improve your overall quality of life. © Verywell, 2018 Frequent Symptoms The symptoms of gout can vary by the stage of the disease. Attacks occurring during the early stages can often be mild and manageable, but they tend to worsen with each subsequent attack. The three stages are broadly described as follows: Asymptomatic hyperuricemia in which there are no symptoms but uric acid crystals are starting to form around a joint Acute intermittent gout in which symptoms develop and recur Chronic tophaceous gout in which uric acid crystals form into chunky deposits, called tophi, in and around joint spaces. This causes persistent inflammation and other long-term complications Acute Intermittent Gout Without medication, acute gout flares can last from hours to weeks. While the pain can strike suddenly, it tends to intensify in the early part of an attack before gradually resolving. Over half of cases will involve the metatarsal-phalangeal joint at the base of the big toe. Other common sites include the knee, ankle, heel, midfoot, elbow, wrist, and fingers. This photo contains content that some people may find graphic or disturbing. See Photo Gout in foot. 4kodiak / Getty Images Attacks are more likely to occur at night or in the early morning hours. This is due, in part, to nighttime dehydration (which increases the uric acid concentration) and lower body temperatures (which promotes uric acid crystallization). The most common signs of a gout attack include: Sudden and severe joint pain which some sufferers describe as being akin to breaking a bone, getting stabbed with glass, or having a severe burn Joint swelling, redness, and warmth triggered by acute inflammation Joint stiffness and pain with movement Mild fever Fatigue Gout attacks can often occur in clusters when uric acid levels are persistently elevated (a condition known as hyperuricemia). Generally speaking, the first 36 hours will be the most painful, after which the pain will begin to subside, albeit gradually. Chronic Tophaceous Gout Chronic hyperuricemia can lead to the extensive formation of tophi under the skin and in and around a joint space. The accumulation of these hard, lumpy deposits can erode bone and cartilage and lead to the development of chronic arthritis symptoms. Over time, the joint can become deformed and interfere with mobility and movement. Even though most tophi will develop in the big toe, around the fingers, or at the tip of the elbow, tophi nodules can appear practically anywhere in the body. In some cases, they can penetrate the skin and cause crusty, chalk-like nodules. They have also been known to develop in the ears, on the vocal cords, or even along the spine. This photo contains content that some people may find graphic or disturbing. See Photo Tophi caused by gout. DermNet / CC BY-NC-ND Complications The joints and skin are not the only organs that can be affected by gout. Long-term, untreated hyperuricemia can also lead to the formation of crystals in the kidneys and the development of kidney stones. In severe cases, a condition known as acute uric acid nephropathy (AUAN) may develop, leading to kidney impairment and a rapid reduction in renal function. People with underlying kidney dysfunction are at greatest risk. The symptoms of AUAN can vary by the degree of impairment but may include: Decreased urine output High blood pressure Nausea Fatigue Shortness of breath Anemia Tissue swelling (edema), mostly in the lower extremities "Uremic frost" in which urea is excreted in sweat crystallizes on the skin When to See a Healthcare Provider Not everyone with gout will experience worsening symptoms or need urate-lowering therapy. With that being said, if you ignore symptoms or fail to take action to avoid attacks, you may end up causing yourself long-term harm. People with gout will sometimes think that the prolonged absence of symptoms means that the disease has spontaneously disappeared. This is usually a fallacy. Unless the underlying cause of high uric acid levels is controlled, the disease can advance silently and reap irreversible harm. For some guidance on talking with a medical professional about your gout, use our Healthcare Provider Discussion Guide below. It can help you start a conversation with your healthcare provider about symptoms, treatment options, and more. Gout Healthcare Provider Discussion Guide Get our printable guide for your next healthcare provider's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. The following are reasons why you should definitely see a healthcare provider about your gout: This is your first attack. Even if treatment is not prescribed, you might benefit from lifestyle modifications to reduce the risk of future attacks. Your symptoms don't improve after 48 hours or last for more than a week. If you are on therapy, this may be an indication that changes need to be made, including dietary and lifestyle interventions. You have a high fever. While a mild fever can accompany a gout attack, a high fever (over 100.4 degrees F) may be a sign of an infection. Frequently Asked Questions What does gout look like? Gout causes joint swelling and redness. In a typical presentation, gout affects the metatarsal-phalangeal joint at the base of the big toe and causes a lump that looks similar to a bunion but is bright red and warm. What does gout pain feel like? Gout pain is severe and strikes suddenly. It can feel like a broken bone, being stabbed in the joint, or a severe burn. The pain intensifies before gradually resolving. It is typically located at the base of the big toe, but can also affect knees, ankles, heels, mid-feet, elbows, wrists, or fingers. How long does a gout attack last? A gout flare-up can last a few hours to weeks. Attacks are more likely to occur at night or early in the morning. In general, the first 36 hours of a gout attack are most intense, then the pain gradually subsides. Causes and Risk Factors of Gout Was this page helpful? Thanks for your feedback! Dealing with chronic inflammation? An anti-inflammatory diet can help. Our free recipe guide shows you the best foods to fight inflammation. Get yours today! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 8 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Igel TF, Krasnokutsky S, Pillinger MH. Recent advances in understanding and managing gout. F1000Res. 2017;6:247. doi:10.12688/f1000research.9402.1 Cleveland Clinic. Gout. Centers for Disease Control and Prevention. Gout. Stewart S, Dalbeth N, Vandal AC, Rome K. The first metatarsophalangeal joint in gout: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2016;17:69. doi:10.1186/s12891-016-0919-9 Choi HK, Niu J, Neogi T, et al. Nocturnal risk of gout attacks. Arthritis Rheumatol. 2015;67(2):555-62. doi:10.1002/art.38917 Ragab G, Elshahaly M, Bardin T. Gout: An old disease in new perspective - A review. J Adv Res. 2017;8(5):495-511. doi:10.1016/j.jare.2017.04.008 Cleveland Clinic. High Uric Acid Level. Khanna PP, Gladue HS, Singh MK, et al. Treatment of acute gout: a systematic review. Semin Arthritis Rheum. 2014;44(1):31-8. doi:10.1016/j.semarthrit.2014.02.003 Additional Reading Jabalameli, M.; Bagherifard, A.; Hadi, H. et al. "Chronic Topherous Gout." QJM: An International Journal of Medicine. 2017; 110(4):239-40. DOI: 10.1093/qjmed/hcx019. Richette, P. and Barden, T. "Gout." Lancet. 2010; 375(9711):318-28. DOI: 10.1016/S0140-6736(09)60883-7. Vargas-Santos, A. and Neogi, T. "Management of Gout and Hyperuricemia in CKD." Amer J Kidney Dis. 2017; 70(3):422-39. DOI: 10.1053/j.ajkd.2017.01.055.