Signs of Gout: How It Starts and How It Manifests

Gout is an inflammatory arthritis in which severe pain, swelling, and redness suddenly appear in a joint. Most often the first attack occurs in the big toe, but other joints can also be targets. Let's look at how gout starts, how it looks at onset, and by what signs it can be suspected.

First signs of gout: how an attack begins

A gout attack often begins suddenly, at night, with intense pain that wakes the person. The skin over the joint becomes hot, and the joint itself swells and turns red.

Left untreated, an attack usually lasts from one to two weeks, and each subsequent one may last longer. Between attacks there are usually no symptoms, but the intervals vary: some people have flare-ups every few months, others once every few years.

Sometimes something precedes the attack:

• an illness with high fever;
• a lot of alcohol or a very heavy meal;
• dehydration;
• joint injury;
• taking certain medications.

Where it hurts in gout: which joints are affected

Usually one joint becomes inflamed at a time. The classic location is the big toe, but the list is broader: other toes, the foot, the ankle, the knee, as well as the hands, wrists, and elbows. Attacks more often begin in the first toe or in the joints of the lower limb.

What gout looks like: swelling, redness, and tophi

Externally, an attack looks like a hot, swollen joint with reddened skin over it. On dark skin, redness is harder to notice. With a long course, tophi appear under the skin — hard deposits of urates, usually on the auricles, fingers, or elbows. At first they are painless, later they may hurt, change the shape of the joints, and damage bone tissue.

The course of gout: from the first attack to a chronic process

Gout is a chronic metabolic disease: it is based on the accumulation of uric acid and reduced excretion by the kidneys, which causes urate crystals to be deposited in tissues. Hyperuricemia occurs in 4–12% of the population, but an elevated uric acid level by itself does not equal disease. In the USA and Europe, about 2% of residents have gout, the male-to-female ratio is from 7:1 to 19:1, with the peak in men at 40–50 years and in women at 60 years and older.

If gout is not treated, attacks become more frequent and longer, tophi appear, kidney stones and persistent joint damage are possible.

How gout differs from other joint diseases

There is pseudogout — calcium pyrophosphate arthritis: the symptoms are similar, and it is sometimes confused with gout, but the cause is calcium phosphate deposition, not uric acid. It is also necessary to distinguish infection inside the joint: it causes increasing pain along with very high fever, chills, nausea, or inability to eat.

When to see a doctor for signs of gout

People go to the doctor at the first appearance of symptoms, and also if the usual treatment has stopped helping. At the appointment, they ask about diet and alcohol and order a blood test for uric acid; if the picture is unclear, they refer to a rheumatologist, take a sample of fluid from the joint with a thin needle, and perform ultrasound or a special CT scan.

Gout by itself is not a reason to call an ambulance. You need to call 103 or 112 if sudden joint pain and swelling are accompanied by increasing pain, very high fever (or a feeling of heat, cold, chills), nausea, or inability to eat: this may be how an infection inside the joint manifests.

What to discuss at the appointment: whether the diagnosis has been confirmed by joint fluid testing, what your blood uric acid level is, whether a rheumatologist's examination is needed, and what tests are ahead. This is reference material; it does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer