Overview

Gout is a common type of arthritis that can affect people of both genders and of all ages. However, it is four times more common in men than in women because of higher uric acid levels in men. Women of reproductive age are unlikely to develop gout due to the protective action of the estrogen hormone.

After menopause, women become more vulnerable. Overall, the risk is highest in both men and women after the age of 40 years.

Gout develops due to excess of uric acid in the blood. As explained in the causes, crystals of monosodium urate (a uric acid derivative) are deposited in the joints, which give rise to gout symptoms. These symptoms are typical and more severe at night.

An acute gout attack is typically characterized by the sudden onset of severe pain, extreme tenderness, swelling, warmth, and redness of the affected joint. The pain sets in during the night and is severe enough to awaken you from your deep slumber.

The metatarsophalangeal joint at the base of the big toe is most commonly affected and accounts for 50% of all joints affected. When gout involves the big toe, it is called Podagra. The other joints that may be affected are those of the feet, ankles, knees, wrists, fingers, and elbows. The arthritis of gout is also called gouty arthritis.

Gout usually affects one joint, but if left untreated, it can affect several joints at the same time. Acute gout affects one joint and its symptoms can last usually for up to one week to ten days.

Chronic gout can affect more than one joint and there are repeated episodes of pain and inflammation. Treatment is long term.

Symptoms and signs of gout

The pain of a gout attack peaks after about 12 hours.  If left untreated, these intense symptoms of the first attack usually last for 3 to 4 days with the pain gradually subsiding over the following week. Typically, the gout pain and inflammation disappear on their own.

Gout Pain

The metatarsophalangeal joint located at the base of the big toe is most commonly affected. The other joints that may be affected are those of the feet, ankles, knees, wrists, fingers, and elbows. The most typical symptom is excruciating pain in the affected joint.

The pain of gout is more severe during the night and awakens the patient from sleep. Even the slight pressure from a bed sheet causes severe pain.
In acute attacks of gout, the pain has a sudden onset. The pain may subside in a few hours or a few days. However, it is not uncommon to see gouty arthritis attacks last for a few weeks.

Tenderness and swelling

On examination of the affected joint (usually the joint of the big toe), it is found that the joint is warm to touch, it is extremely tender (tender meaning painful to touch or pressure) and swollen.

The pain sets in within for hours of the infection while the swelling begins to appear within twelve hours of the infection

Skin changes

Discoloration of the skin around the affected joint clearly indicates gout and is due to the formation of uric acid crystals beneath the skin, which cause stagnation of blood. As a result, the skin over the joint becomes red or purplish.

The reddening of the skin sets in well before the gout attack and this sign may well be a warning signal. The discoloration may last for long period even after the attack subsides.

As the gout attack subsides, the skin on the joint begins to peel off and there may be associated itching.

Fever

Though usually only one joint is affected by gout, the inflammation in the joint can be so severe as to cause high fever with chills, accompanied by fatigue, malaise, muscle aches, and other flu-like symptoms.

Restricted movement

The movements of the affected joint are restricted. If the joint is damaged you will have joint stiffness.

Multiple joints

Initially, one or two joints may be affected but over time, if left untreated, more joints can be affected.

The metatarsophalangeal joint of the big toe is the most frequently affected. Other joints that are commonly affected are the ankles, knees, elbows, wrists and fingers.

Acute and chronic gout

Many gout patients develop chronic gout, where they get repeated attacks over a period of years. However, the subsequent attacks may not be very painful. About 60% of gout patients develop another gout attack within one year. However, some patients experience only one gouty arthritis attack in their lifetime.

In chronic gout, there is significant destruction of the joint that can lead to joint deformity. Very often in such cases, uric acid tophi develop under the skin that can lead to cartilage and bone destruction.

Appearance of tophi

In chronic gout, painless nodules of uric acid crystals, called tophi, may be seen deposited in the soft tissues over the fingers, elbow tips, in the ears and around the big toe depending on which joint is affected.

However, they may also appear in other parts of the body. The appearance of tophi signifies a substantially high uric acid level in the blood. Kidney stones can also form.

Bursitis

Rarely, when the urate crystals get deposited in the bursa of a joint, it causes bursitis. The bursa is a sac around the joints and the tendons, which contains a fluid that acts as a cushion between the two bones in a joint and which allows for frictionless movements of the joint bones.

Symptoms of bursitis may include pain, swelling, warmth, and redness of the affected joint. Fever may also be present.

Other medical conditions that mimic gout symptoms: Differential diagnosis

The symptoms of gout such as pain, swelling, warmth, and tenderness may also be seen in the following conditions.

Rheumatoid arthritis

The difference here is that RA affects more than one joint and can affect joints of both hands or feet while gout usually attacks one joint and usually of the feet.

Osteoarthritis

Osteoarthritis develops slowly, usually affects one joint and the big joints such as the hip joint and the knee joint.

Septic arthritis

Septic arthritis, also called infectious arthritis, is pyrogenic ( bacterial) infection of a joint and can also present with symptoms similar to those of gout.  Septic arthritis can also be caused by virus or fungi. Typically, septic arthritis affects one large joint, such as the knee or hip.

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