Gout is a form of arthritis causing intense joint pain and inflammation. It develops when elevated uric acid in the blood forms tiny, sharp crystals. These urate crystals often accumulate in and around joints, commonly affecting the big toe, but also impacting ankles, knees, wrists, and fingers.
Asymptomatic Hyperuricemia
The initial phase of gout progression is asymptomatic hyperuricemia. Here, individuals have elevated uric acid in their bloodstream but no noticeable symptoms.
The body produces uric acid as a byproduct when it breaks down purines, natural substances found in the body and certain foods. Normally, kidneys filter uric acid; if the body produces too much or kidneys don’t excrete enough, uric acid levels rise.
Not everyone with hyperuricemia develops gout symptoms. Many have elevated uric acid for years without joint pain or inflammation.
High uric acid levels indicate a predisposition, creating the environment for urate crystal formation. This stage sets the groundwork for future gout attacks if uric acid levels remain unmanaged.
Acute Gout Flare
The second stage of gout is marked by the sudden onset of an acute gout flare. This occurs when urate crystals accumulated in a joint trigger a strong inflammatory response.
The affected joint typically experiences intense pain, swelling, redness, and warmth. Pain often begins abruptly, frequently at night, and can reach peak intensity within 4 to 12 hours.
While the big toe is the most commonly affected joint, gout flares can also occur in the ankles, knees, wrists, and fingers. The pain can be so severe that even the slightest touch, such as the weight of a bedsheet, becomes unbearable. Symptoms from an acute flare can persist for several days to a few weeks before gradually subsiding.
Intercritical Gout
Following an acute gout flare, individuals enter a period known as intercritical gout. This stage is characterized by symptom absence, with the affected joint appearing to function normally.
Despite this symptom-free interval, uric acid levels may remain elevated. Urate crystals continue to accumulate within the joints.
The duration of this symptom-free period varies, ranging from months to several years. Without appropriate management, future gout attacks are likely to recur. Subsequent flares may become more frequent, last longer, and affect multiple joints.
Chronic Tophaceous Gout
The most advanced stage of gout progression is chronic tophaceous gout. This stage typically develops after many years of poorly managed or untreated high uric acid levels.
It is distinguished by tophi formation: deposits of uric acid crystals accumulating under the skin or within joints and soft tissues. These deposits can appear in various locations, including fingers, hands, feet, elbows, and the helix of the ear.
Tophi can lead to ongoing joint pain, stiffness, and joint damage and deformity over time. Prolonged elevated uric acid levels also contribute to other health issues, such as kidney stones. While this stage represents the most severe form of gout, its development can often be prevented with consistent management of uric acid levels.