Stages of Gout


gout damages the bone

diagram of gout in toe

Gout, also known as ‘gouty arthritis,’ is a type of inflammatory arthritis. It is estimated that approximately eight million people have gout in the United States alone. Of that number, approximately three million have had at least one attack within the past twelve months. It develops due to high levels of uric acid in a person’s blood. As the uric acid moves through the blood, it crystalizes and leaves these sharp, needle like crystals in various parts of the body, often the instep, ankle, toes and heel, but also the knee, Achilles tendon, wrist, finger and elbow. Years ago it was called ‘the disease of kings’ because believed that the condition was caused by excessive drinking and a diet of rich foods. Actually, they weren’t too far from the truth.

Stage One Gout:  Asymptomatic Hyperuricemia

During this stage, the patient has hyperuricemia, meaning that they have elevated levels of uric acid in their blood. This stage occurs before any symptoms of gout are present.

Stage Two:  Acute Gout

At this stage, there is an inflammation of the joint, causing sudden swelling and severe pain. It typically happens at night and increases in intensity at a very rapid rate over the next eight to 12 hours. The pain and swelling greatly inhibits mobility making walking and any movement very difficult. After 48 – 72 hours, the pain begins to ease and all symptoms are usually gone within seven to ten days even without treatment. Some people never have another attack, although that is rare. Most people will experience another attack, but the timeframe cannot be predicted. It can occur in a few months, a year or even more.

The attack is usually brought on by an event that causes the uric acid in the blood to spike or causes the crystals that have already formed to jostle in the joint.

Stage Three: Interval Gout

This stage is similar to Stage One in that the symptoms of gout are not present except for the high levels of uric acid in the blood. The crystals are still present in the joint but there are no gout symptoms, no inflammation, no pain and no swelling. However, this does not mean that the patient no longer has gout. In fact, the gout may still be causing damage to the joints due to very low level, painless inflammation.

During this time, it is crucial that the patient take aggressive steps to prevent or reduce future flare ups. In many cases the patient can do things such as change their diet, lose weight and other lifestyle changes that can prevent gout attacks. They can also seek medical treatment and may be able to avoid chronic gout.

Stage Four: Chronic Gout

In this final gout stage, the gout attacks are more frequent and the attacks themselves are longer. As the condition progresses, the patient will experience pain even when there is no gout flare up. The symptoms of gout are more pronounced and more difficult to relieve. Mobility loss is highly likely because the joints are permanently damaged. It takes a long time for the patient to reach this stage of gout so proper medical treatment and lifestyle changes can prevent the condition from progressing to this stage.

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