Gout - Symptoms

Polyarticular Gout. Older people are more likely to have polyarticular gout. In this condition, the joints of the foot, ankle, knee, wrist, elbow, and hand are the most frequently affected. The pain usually occurs in joints on one side of the body and it is usually, although not always, in the lower extremities. People with polyarticular gout are more likely to have a more gradual onset of pain and a longer delay between attacks. Older people are at higher risk for polyarticular gout than younger adults and it tends to occur in the upper extremities, often in the fingers. People with polyarticular gout are also more likely to experience the low-grade fever, loss of appetite, and a general feeling of poor health.

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An untreated attack will typically peak 24 to 48 hours after the initial appearance of symptoms, and subside after 5 to 7 days, although it can last only hoursor as long as several weeks.

Intercritical Gout

Intercritical gout is the term used to describe the periods between attacks. The first attack is usually followed by a complete remission of symptoms, but left untreated, gout nearly always recurs at some point in the future. One study reported that 62% of subjects experienced at least one further attack within a year. At the end of two years, 78% of patients experienced a recurrence. After 10 years, 93% of the patients had had repeat attacks.

Symptoms of Chronic Tophaceous Gout

Development of Chronic Pain. When gout remains untreated, the intercritical periods typically become shorter and shorter, and the attacks, although sometimes less intense, can last longer. Over the long term (about 10 to 20 years) gout becomes a chronic disorder characterized by constant low-grade pain and mild or acute inflammation. Gout may eventually affect several joints, including those that may have been free of symptoms at the first appearance of the disorder. In rare cases, the shoulders, hips, or spine are affected.

Symptoms of Tophi. Tophi, the knobby MSU crystal deposits that form during chronic gout, generally form in the following locations:

Helix of the outer ear (the curved ridge along the edge of the ear)
Forearms
Elbow or knee
Hands or feet -- older patients, particularly women, are more likely to have gout in the small joints of the fingers
Around the heart and spine (rare)

Tophi are generallypainless. However, they can cause pain and stiffness in the affected joint. Eventually, they can also erode cartilage and bone, ultimately destroying the joint. Large tophi under the skin of the hands and feet can give rise to extreme deformities.