Symptoms of Gout

Gout symptoms are associated with gouty arthritis, which can develop when there is excess uric acid in the body. The signs of gout 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. While the severity of gout symptoms can vary, it tends to progress in stages and worsens over time. If left untreated, recurrent attacks can lead to joint deformity and the progressive restriction of movement.

This article details the symptoms of gout, along with some complications of the disease. By recognizing and treating gout early, you can avoid many of these complications and improve overall quality of life.

Frequent Gout Symptoms

Signs of gout can vary by the stage of the disease. Attacks during the early stages of gout can often be mild and manageable, but they tend to get worse with each subsequent attack. 

The three stages are broadly described as follows:

• Asymptomatic hyperuricemia, in which there are no symptoms but uric acid crystals start 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

The most common signs of gout attacks will include:

• Sudden and severe joint pain, described as feeling like a broken bone, severe burn, or getting stabbed with glass
• Joint swelling, redness, and warmth triggered by acute inflammation
• Joint stiffness and pain with movement
• Mild fever
• Fatigue

Over half of all gout cases at the big toe will involve the metatarsophalangeal joint at its base. Other common sites of gout symptoms include the foot, knee, ankle, heel, elbow, wrist, and fingers.

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Gout symptoms can often occur in clusters of attacks, when uric acid levels are persistently elevated. This condition is known as hyperuricemia.

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.

Attacks are more likely to occur at night or in the early morning hours. This is due, in part, to nighttime dehydration that increases the body's uric acid concentration, and lower temperatures that promote uric acid crystallization.

Chronic Tophaceous Gout

Chronic hyperuricemia can lead to the extensive formation of tophi under the skin, and in and around a joint space. The buildup of these hard, lumpy deposits can erode bone and cartilage, and lead to the development of chronic tophaceous gout and chronic arthritis symptoms.

Over time, the joint can become deformed and interfere with mobility and movement.

Most tophi will develop in the big toe, around the fingers, or at the tip of the elbow, but 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.

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Gout Complications

The joints and skin are not the only organs that can be affected by gout. Long-term, untreated hyperuricemia can cause crystals to form in the kidneys, leading to 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. The symptoms of AUAN can vary by severity, but they 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

People with underlying kidney disease are at greatest risk of developing AUAN.

When to See a Healthcare Provider

Not everyone will experience gout symptoms that get worse or need urate-lowering therapy. However, if you ignore symptoms or fail to take action to avoid attacks, it may lead to long-term complications.

People with gout will sometimes think that a prolonged absence of symptoms means that the disease has spontaneously disappeared. This is usually not true. Unless the underlying cause of high uric acid levels is controlled, often through changes in diet, then gout can advance silently.

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, gout 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

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Diagnosis

You should see a healthcare provider to determine a gout diagnosis or the progression of the disease. This is especially true if:

• This is your first attack. Even if treatment is not prescribed, you might benefit from diet and other 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.
• 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.

A diagnosis will include a physical exam and a history of your health. It also may include tests that are used to determine the cause of gout symptoms. Some common tests used to diagnose gout include:

• A synovial fluid analysis, used to identify crystals or tophi in the fluid surrounding the joint
• Blood tests to evaluate kidney function, such as creatinine levels, and blood cell counts
• Urine samples to check for uric acid levels
• X-rays or other imaging tests to evaluate bone health or deformity, or changes in a joint

These tests can be used to rule out pseudogout, septic arthritis, and other more common types of arthritis that are among the conditions that can be mistaken for gout.