Gout Symptoms: Recognizing Signs for Timely Diagnosis and Management

Gout Symptoms: Recognizing Signs for Timely Diagnosis and Management

Before the first gout attack occurs and the disease is discovered, a gout disease has often existed for years. The phase in which uric acid levels rise slowly but without showing symptoms is called the asymptomatic phase. Typical gout symptoms only become noticeable when the level reaches a critical point, and a gout attack occurs.

pain in the toes

A gout attack typically causes severe pain. The joint in the big toe is particularly frequently affected (podagra). In addition to the pain, the joint can be reddish, severely swollen and overheated. It is also susceptible to touch. In some cases, those affected can only step on their heels, which leads to a limping gait.

In addition to the toe joint, a gout attack can also cause problems in the thumb joints, the knee joints, the ankle joints and the joints in the metatarsus. If the disease is not treated appropriately and the lifestyle is not adjusted, chronic pain can be the result.


Uric acid builds up in the joints.

In gout, the pain is caused by uric acid crystals building up in the body. This happens preferably in the skin, the joints, the tendons, the ear cartilage and the bursa. Painful joint inflammation can then develop as a result of the deposits.

If the inflammation is not treated, it can lead to chronic damage to the joints in the long term. Damage to other organs, such as the kidneys, is also possible. The uric acid crystals are also deposited here and, over time, can lead to kidney stones and, in the worst case, to a functional failure of the kidneys.

Visible nodules sometimes form due to the deposits of the crystals. These are called gout tophi. However, tophi only form when there are larger clumps of crystals. This is rarely the case with today’s treatment options – often when gout is not treated.

chronic course

The first gout attack usually comes as a complete surprise to those affected. Often, these are healthy people who do not know anything about their illness. An acute gout attack can last from several hours to a few days. Once the symptoms have subsided, the gout attack is usually followed by a longer symptom-free phase.

However, if no therapy is given, gout attacks can occur again and again. The symptoms usually get worse over time. Specifically, this means that the attacks occur at shorter intervals, last longer and can also spread to other joints.

If the disease takes a chronic course, serious complications can also occur. These include, for example:

  • constant pain
  • chronic joint inflammation
  • joint deformities
  • bursitis
  • Kidney stones, kidney weakness and kidney failure

However, chronic gout is relatively rare. It only occurs if the disease is not treated or not sufficiently treated.


diagnosis of gout

Based on the typical symptoms, the doctor can often already make the suspected diagnosis of gout. A blood test can then determine the current uric acid level. However, this does not necessarily have to be increased during a gout attack. Therefore, regular measurement of the values ​​is more meaningful than a one-off test.

In addition to a blood test, a urine sample can also provide further information. Because while the uric acid level in the blood is usually higher in gout, it is lower than usual in the urine. 

Joint puncture and X-ray

Suppose there are still doubts about whether the patient has gout after the blood test. A joint puncture with subsequent examination of the synovial fluid can provide a precise result. The uric acid crystals in the liquid can be seen under the microscope.

On the other hand, an X-ray examination makes little sense in the early stages of the disease. However, if the course is advanced, an X-ray can be helpful for diagnosis. Then, there are often already visible changes in the joints.


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