Gout - symptoms and signs

Gout occurs mainly in middle-aged men, who represent 90% of all gout sufferers. Often they are obese and suffer from high blood pressure (hypertension). The remainder are usually post-menopausal women; gout is rare in children.

Signs and symptoms include the following:

Acute gouty arthritis

• Sudden onset of intense pain in a joint, typically the big toe, sometimes also the ankle, knee, elbow or wrist.
• The onset can be almost immediate, or over minutes to hours.
• Swelling, inflammation and a feeling that the joint is very hot.
• Tense, warm, shiny red or purplish overlying skin.
• Occasionally, in extreme cases, chills and fever.

Although susceptibility to gout is probably something one is born with, the first attack of gouty arthritis usually does not appear until middle age, mainly in men. The first few attacks may come (often at night) and go without apparent reason, but are often precipitated by the factors above. The symptoms usually settle down within days.

With prompt treatment, the pain and inflammation can be brought under control quickly, although attacks can recur if the underlying problem, a high urate level, is not treated. Later untreated attacks may persist for weeks or even become chronic with daily pain.

Chronic joint symptoms

• Asymptomatic intervals tend to become shorter as the disease progresses. Attacks start to occur more frequently and may start to develop in more than one joint and in unusual sites including knees, hands and elbows.
• Joints can become permanently deformed as a result of erosion by the crystals, so that hands and feet lose their mobility. In rare cases, the shoulder, chest joints or neck vertebrae may be involved.

When gout has been present for a longer period, urate deposits called “tophi” develop. They appear as small, hard lumps around ankles, hands, the tips of the elbows, earlobes and even around the vocal chords and the spinal cord.

• Eventually they can cause pain or stiffness.
• They can also protrude and finally erupt, causing a discharge of chalky material, containing urate crystals.
• Neglected tophi cause damage to the underlying bone and joints and are an absolute indication to treat the underlying condition and not just the symptoms of the attacks.

Generally, because gout is such a painful affliction, people seek help and receive treatment. If the diagnosis is made early, current therapy can permit a normal life. However, if treatment is not followed or urate levels remain high, the disease can eventually cause serious joint afflictions and kidney problems.

For those with advanced disease, it is possible to correct joint structure to a degree. Tophi can be resolved, joint function improved, and kidney problems stopped.

About 10 to 20% of gout sufferers develop kidney stones. These may lead to obstruction and infection, which may damage kidney tissue. Many people with gout have high blood pressure. This condition can also damage the kidneys. In these cases, progressive destruction of kidney tissue may lead to further problems with urate excretion, which further raises urate levels.

When gout appears before the age of 30 it tends to be more severe.

When to see a doctor
Call your doctor if:

• Joint pain develops suddenly, especially when there has been no physical injury and if the pain is associated with redness and extreme tenderness.
• Joint pain recurs or lasts more than a few days, especially when associated with chills or fever (rheumatoid arthritis needs to be excluded).
• When, in known gout, symptoms become more severe or side effects of medication (allopurinol or colchicine) occur.
• When any severe colicky back pains develop and radiate into the groin – this may be caused by a kidney stone.
• If you are developing lumps (tophi).
• If attacks are more frequent or if they are affecting different or multiple joints.
• If the attacks are frequent and not settling and/or tophi are developing, consider asking your doctor about seeing a specialist.
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