Gout is a form of inflammatory arthritis caused by a buildup of uric acid crystals in a joint that can cause sudden, severe episodes of pain, tenderness, redness, warmth and swelling. It most often affects the joint of the big toe but it can affect other joints as well. The Arthritis Foundation states that gout affects nearly 4% of Americans and is more common in men than women. Yet few people understand what gout is and what to do about it.
The stages of gout
According to the Arthritis Foundation, there are four stages of gout:
Stage one: asymptomatic
There are no symptoms or pain in this stage, but blood uric acid levels are high and crystals are forming in the joint.
Stage two: acute
A gout attack happens when something (often a night of drinking) causes uric acid levels to spike or jostles the crystals that have formed in a joint, triggering the attack. The resulting inflammation and pain usually strikes at night and intensifies over the next eight to twelve hours. The symptoms ease after a few days and will likely go away in a week to 10 days. Some people never experience a second attack, but an estimated 60% of people who have a gout attack will have a second one within a year. Overall, 84% may have another attack within three years.
Stage three: interval
Gout is rarely a continuous problem – rather it tends to happen in relatively short-lived, very painful attacks. Interval gout is the stage during the time between attacks where there is no pain but low-level inflammation can still cause joint damage. Lifestyle changes and other treatment options are important at this stage to prevent future attacks or damage.
Stage four: chronic
Chronic gout develops in people who uric acid levels remain high over a number of years. Attacks become more frequent and the pain may not go away.
What causes uric acid crystals to build-up?
Uric acid is created and released into the blood during the breakdown of a substance in food called purines. Normally, the uric acid is filtered out out the blood through the kidneys and passes out of the body though urine. Higher than normal levels of uric acid in the blood may be caused by kidney damage or disease, making it hard for the kidneys to clear the uric acid. However, sometimes the build-up is caused by increased production of uric acid. Common causes of increased production include:
- Excess consumption of foods high in purines like steak, seafood, and organ meats
- Consumption of foods that encourage high uric acid levels, such as alcohol or sugary drinks
- Certain medications, such as diuretics, salicylate-containing medications (like aspirin), niacin, or levodopa
- Medical conditions such as high blood pressure, hypothyroidism, Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome
When it’s time to see a doctor
Gout attacks are sudden, painful, and can cause joint damage over time – even during the time between the attacks – which can lead to a loss of mobility. If you experience the sudden onset of pain, tenderness, redness, warmth, and swelling – particularly in your big toe – it is time to see the doctor. Once diagnosed with gout, it is important to regularly visit your doctor to learn proper management and treatment that can prevent your gout from becoming chronic. With regular medical visits and smart lifestyle changes, you can live an active life with gout.
