Uric acid is a waste product normally present in the blood as a result of the breakdown of purines. Purines are part of all human tissue and are found in many foods. Eating foods high in purines can raise uric acid levels in the blood and precipitate gout attacks in some people.
Excess uric acid in the blood (hyperuricemia) is caused by increased uric acid production in the body or inadequate elimination of uric acid from the body. It's important to recognize gout signs and symptoms so that future gout attacks can be prevented or properly treated. About one in 100 people are affected by gout and perhaps as much as 7 percent of older men.
Recognizing Gout Symptoms
Gouty arthritis is a term used to describe painful, recurring attacks of joint inflammation. Generally, there are three stages of gout. Some medical literature counts a fourth stage as the period between gout attacks. The three stages are:
Asymptomatic hyperuricemia - elevated blood uric acid without symptoms of gout
Acute intermittent gout - one joint becomes inflamed and painful, typically lasting for about 2 weeks if untreated and less if treated. Symptoms may not recur for weeks, months or years.
Chronic tophaceous gout - affected joint becomes more frequently inflamed and uncomfortable. More than one joint may be affected at this stage. Crystals may collect and form tophi which are lumps underneath the skin. The development of kidney stones is also possible at this stage.
During the acute intermittent stage, the feet, or more specifically, the big toe (see photo) is most commonly involved. The affected joint typically is:
- shiny red
- extremely painful
Gout is more common in men, women after menopause, and people with kidney disease. Gout has been linked to obesity, hypertension, hyperlipidemia, and diabetes. There may be genetic factors involved since gout tends to run in families.
The Typical Gout Attack
- The onset of a gout attack is usually quick. Often gout symptoms (warmth, swelling, redness, and pain) begin during the night.
- Over an 8 to 12 hour period the pain level worsens, going from mere twinges to intense pain.
- The big toe is affected in 90 percent of people with gout. Midfoot, ankles, heels, and knees are fairly common sites too, with wrists, fingers, and elbows being less common.
- Walking is difficult when a gout attack affects lower extremities.
- Fever, chills, and malaise (i.e., not feeling well) may also accompany acute gout attacks.
The goal of gout patients is to minimize or prevent future gout attacks. Getting early treatment, when inital gout symptoms occur, and lifestyle modifications are important measures to take.
Gout Fact Sheet. American College of Rheumatology. June 2006.
Gout - What is it? Arthritis Foundation. July 9,2007.
Gout. Primer on the Rheumatic Diseases. Edition 12. Arthritis Foundation.