Gout is characterized by attacks of acute and searing pain in the affected joint, which becomes hot, red and swollen with shiny overlying skin and dilated veins. Gout may be acute or chronic (long term).
In more than 70 per cent of patients, the joint most commonly first affected is that at the base of the large toe. The ankle, knee, the small joints of the feet and hands, the wrist and the elbow are the next most frequently affected, in that order. The main skeleton or large joints such as the hip and shoulder are rarely involved.
The onset of an attack of gout may be slow or extremely sudden. The pain may be sufficient to wake a sufferer from sleep and attacks commonly start at night or in the early hours of the morning. Attacks can sometimes be accompanied by fever and preceded by anorexia, nausea and mood change. If untreated, attacks last a few days or weeks and then subside on their own. Local itching and skin flaking may follow.
Some patients only ever experience a single attack of gout, or have another attack only after an interval of many months or years. However, the tendency is for attacks to recur and to increase in frequency and duration so that they become more or less continuous. Acute attacks may follow dietary excesses, an increase in alcohol consumption, a starvation diet, use of diuretic drugs or by improperly monitored use of drugs used to treat gout. Trauma, excess exercise, surgery or severe illness can also precipitate an attack.
In patients who experience recurrent attacks of gout, progressive cartilage and bone erosion can take place with deposits of urate crystals occurring in and around the joints and soft tissues. These deposits present as tophi and are often seen on the ears and elbows. If left untreated, a majority of patients with recurrent gout will develop tophi within 10 years and experience subsequent crippling degenerative arthritis.
Urate calculi and kidney disease
In a small number of patients, especially in hot climates, urate calculi (stones) develop and can cause renal colic and a decline in kidney function.