What Are Gout Symptoms?

Gout, considered one of the most painful forms of inflammatory arthritis, has inflicted pain on humanity for thousands of years—from Egyptian royalty to the English aristocracy. In fact, excruciating pain and inflammation—typically in your big toe—are the classic symptoms of a gout attack.

Today, gout is the most common kind of inflammatory arthropathy in the United States, where it affects approximately 4% of adults.

Rest assured, most people with gout will experience only one acute attack in their life. With an acute gout attack, symptoms will go away within a few days, and you may never have another attack again.

But for some people, gout can be a progressive condition. These people can have frequent gout attacks, and the attacks generally last longer than the initial attack. People with frequent gout attacks can go on to develop chronic gout, and these people will most likely experience joint damage. They’ll have to take medications long-term to prevent gout attacks.

Although everyone is different, and it’s difficult to predict when a gout attack will occur, it’s important to be aware of the warning signs, especially when you have chronic gout.

Common Symptoms of a Gout Attack

Pain and inflammation are the most common symptoms of a gout attack. Gout-related pain is sometimes described as sharp, throbbing, and crushing. The pain usually occurs without warning—it can wake you up in the middle of the night, or you might notice it first thing in the morning.

When you have a gout attack, the pain is constant, and the severity of the pain can fluctuate throughout the attack. Although attacks usually last about three to five days, the pain is most severe within the first 24 hours after the attack begins. After the pain goes away, you may notice some discomfort in the affected joint. This discomfort can last from a few days to a few weeks.

In addition to the pain, you may also notice that the affected joint is stiff, swollen, warm, red, and very tender. Those are signs of inflammation.

In addition to pain and inflammation, there are some other signs and symptoms of a gout attack you should look for:

• Only one joint is affected: Your first gout attack generally affects only one joint (most often in the big toe, ankle, or knee), but other joints can be affected, too. You can also develop gout in the insteps of the feet, heels, elbows, wrists, and fingers. If you have more than one gout attack, the joint that’s affected typically doesn’t change. For example, if you have a gout attack in your toe, the next time you have an attack, it will likely be in that same toe. However, if gout becomes chronic, more joints can become involved.

• Fever: Some people have a fever during a gout attack.

Not everyone who has a gout attack will have all of these symptoms. You may have just a couple of symptoms.

How to Recognize Chronic Gout

It’s still possible to experience gout attacks with chronic gout. When you have chronic gout, you can have flares—a period of time when your symptoms intensify. Therefore, you need to be able to recognize the signs of a gout attack and work hard to prevent attacks.

In general, your doctor can make a chronic gout diagnosis if you experience two or more acute gout attacks within a 12-month period. Remember, pain and inflammation aren’t constant when you have chronic gout, but both symptoms do flare when you have a gout attack.

Additionally, your doctor will look at your uric acid levels. Extremely high levels of uric acid (greater than 12 mg/dL) may help your doctor with a chronic gout diagnosis. (In general, uric acid levels should be about 4 to 5 mg/dL). High levels of uric acid can also cause uric acid crystals to collect in your kidneys, which can lead to kidney stones—another chronic gout symptom.

Another sign of chronic gout is tophi. Tophi are chalky deposits of uric acid that look like little lumps under the skin of the affected joint. They usually develop only after you’ve had gout for several years.

Furthermore, multiple joints can be involved with chronic gout, and these joints can become damaged over time if gout is left untreated. Range of motion can also decrease in these joints. Your doctor can spot the first signs of joint abnormalities in imaging tests such as X-rays.

What to Do If You Have Gout Symptoms

If you develop gout symptoms such as sudden, excruciating pain in one of your joints, call your doctor. Although an acute gout attack will go away on its own even if you don’t treat it, gout that’s left untreated can eventually lead to more severe pain and joint damage. Recognizing the signs and symptoms of a gout attack can help you prevent future attacks.