Gout - Symptoms

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Symptoms

Gout is often divided into four symptomatic stages:

Asymptomatic hyperuricemia
Acute gouty arthritis
Intercritical gout
Chronic tophaceous gout

These stages may differ depending on the age of onset:

In middle-aged adults, symptoms are more likely to occur in one joint, most often in the lower limbs. About 60% of cases in this age group first occur in the big toe.
In elderly people, symptoms are more likely to occur in a number of joints in the upper extremities, particularly the fingers.

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Asymptomatic Hyperuricemia

Asymptomatic hyperuricemia, in which MSU slowly builds up, always precedes gout and is considered the first stage of the disorder. It lasts for an average of 30 years.

Note: Hyperuricemia does not inevitably lead to gout. In fact, less than 20% of the hyperuricemic population develops the full-blown arthritic disease.

Acute Gouty Arthritis

Acute gouty arthritis occurs when the first symptoms of gout appear. Sometimes gout is heralded by brief twinges of pain (petit attacks) in an affected joint, which can precede the actual full-blown condition by several years. MSU crystals form at normal body temperature when concentrations in the blood reach 7 mg/dL. At lower temperatures, crystals form at lower concentrations. Since blood temperature falls with distance from the heart, gout strikes the toes and fingers first.

The symptoms of acute gouty arthritis are described as follows:

The primary symptom is severe pain at and around the joint. Some patients describe it "crushing" or resembling a dislocated bone. The area can be so tender that walking and even the weight of bed sheets can be unbearable. One writer described gout in the toe as feeling like ?walking on my eyeballs.? The pain usually takes 8 to 12 hours to develop. In many cases the attack occurs late at night or early in the morning and may awaken the patient from sleep.
Swelling may extend beyond the joint, indicating fluid build-up within.
The skin over the affected area is often red, shiny, and tense. After a few days it may start to peel.
Chills and mild fever, loss of appetite, and feelings of ill health may occur with an attack.

Most often symptoms first start in one joint, a condition is called monoarticular gout. If more than one joint is affected, it is known as polyarticular gout. (Multiple joints are affected in only 10 - 20% of first attacks.)

Monoarticular Gout. The joint of the big toe is the site of about 60% of all f irst monoarticular gout attacks in middle-aged adults. This occurrence is known as podagra. (The site is medically referred to as the big toe?s metatarsophalangeal joint, the point where one of the five long bones of the foot meets the first digit of a toe.) Symptoms can also occur in other locations, although most often they develop somewhere on one lower limb in middle-aged men.