Symptoms of Gout

Gout is an inflammatory joint disease closely related to abnormal uric acid metabolism. Its core symptoms mainly manifest as episodic joint pain and swelling. When blood uric acid levels are excessively high, monosodium urate crystals deposit in the joints or surrounding tissues, triggering an acute inflammatory response. The severity and frequency of symptoms vary among individuals, ranging from occasional mild discomfort to severe acute attacks that may render walking impossible.

The symptoms of gout exhibit the typical "acute attack-remission cycle" characteristic. In the early stages, there may only be brief abnormal sensations in the joints, but as the disease progresses, the frequency and duration of attacks may gradually increase. Patients often experience sudden symptoms at night or early morning, with the first attack usually affecting the big toe, but ankle, knee, wrist, and other joints can also be involved. Recognizing these early signs is helpful for early diagnosis and treatment, preventing long-term complications such as joint damage or kidney problems.

Early Symptoms and Signs

Early signs of gout may be easily overlooked and often present with the following features:
• Intermittent joint discomfort: Patients may feel mild swelling or burning sensations in the toes, heels, or other areas after exercise or weather changes
• Brief stabbing pain: Sharp, needle-like pain may occur around the joint, lasting for minutes and then subsiding spontaneously
• Mild swelling: Reversible swelling may appear around the joint, but the appearance is not obvious

These early signs may occur several times a week or month, but due to their mild and self-limiting nature, they are often mistaken for sprains or overuse injuries. It is noteworthy that some patients may have had metabolic abnormalities for years before their first acute attack, without obvious symptoms.

Common Symptoms

Typical Presentation During Acute Attacks

The typical symptoms of acute gout include:

• Severe pain: The pain can be so intense that walking becomes difficult, often rated 7-10 out of 10
• Redness, swelling, warmth, and tenderness: The affected area shows redness, swelling, warmth, tenderness, and often increased skin temperature
• Sudden onset: 70% of patients wake up at night due to intense pain, unable to maintain a specific posture

The attack usually peaks within hours and lasts from several days to two weeks. About 20% of patients experience multiple joints affected during their first attack, which indicates a higher risk of developing chronic gout later. Symptoms may completely resolve between attacks, but metabolic abnormalities persist.

Differences in Symptoms at Specific Sites

Symptoms vary depending on the affected joint:
• First metatarsophalangeal joint: About 50% of initial attacks occur here, often with skin peeling or scaly rash
• Heel and ankle joints: Pain may radiate down the calf, affecting walking stability
• Fingers and wrists: May be misdiagnosed as rheumatoid arthritis; uric acid testing is needed for confirmation

It is also noteworthy that about 15% of patients have nodular lumps at the first attack, which may be early signs of tophi. The appearance of these subcutaneous nodules indicates the disease has entered a chronic stage and requires immediate adjustment of treatment strategies.

Disease Progression and Symptom Changes

In the early stages, the intervals between attacks may last several years, but as uric acid metabolism abnormalities persist, the frequency of attacks may gradually increase:
• The first attack interval averages 1-2 years
• Untreated patients may develop monthly attacks within 10 years
• Long-term uncontrolled cases may develop "chronic gouty arthritis," leading to permanent joint deformities

Features of the chronic stage include:

• Gouty tophi: Commonly found on the auricle and joint prominences, ranging in size from a grain of rice to a goose egg
• Persistent low-grade pain: Even between attacks, joints may be tender to pressure
• Joint dysfunction: Long-term attacks may cause deformities, such as lateral deviation of toes or reduced joint mobility

In patients with poor metabolic control, about 30% may develop kidney stones within 10 years, presenting as back pain, hematuria, or dysuria. These renal complications may occur simultaneously with or separately from joint symptoms and should be confirmed through ultrasound or X-ray to locate crystal deposits.

When to Seek Medical Attention

Seek professional medical help immediately if you experience:

• First-time unexplained joint severe pain, especially in the first metatarsophalangeal joint
• More than three attacks within six months
• Subcutaneous nodules or white lumps under the skin
• Fever with persistent joint redness and swelling lasting over 72 hours

Even if symptoms subside, continuous monitoring of uric acid levels is necessary. If you notice the following signs of chronic complications, schedule a specialist evaluation promptly:
• Long-term joint stiffness with morning activity limitation
• Persistent kidney discomfort with abnormal urination
• Frequent attacks despite regular treatment

Early diagnosis can be confirmed through blood uric acid testing and joint fluid analysis for crystal presence. Delayed treatment may lead to irreversible joint damage. The progression of gout symptoms is closely related to metabolic control. Patients should establish a long-term habit of monitoring uric acid levels and maintaining a symptom diary for health management.

 

Frequently Asked Questions

Besides medication, what immediate methods can relieve gout pain during an attack?

In addition to prescribed pain medications, applying ice packs to the affected joint for 15-20 minutes several times a day can reduce swelling. Avoid weight-bearing on the affected joint, elevate it above heart level, and keep the environment warm to prevent further discomfort.

In dietary control, besides avoiding high-purine foods, what other principles should be followed?

Reduce intake of red meats, shellfish, and alcohol, which are high in purines. Increase consumption of low-fat dairy products and low glycemic index (GI) foods. Limit sugary drinks and processed foods, and ensure adequate intake of vitamin C (such as citrus fruits), which helps lower blood uric acid levels.

Can gout patients perform light exercise during an acute attack?

During an acute attack, strenuous exercise should be avoided. Light activities like slow walking can promote blood circulation. The affected joint should be completely rested and protected from pressure; if pain is severe, bed rest is recommended until symptoms improve, then gradually resume exercise.

Is regular kidney and liver function monitoring necessary for long-term uric acid-lowering medication use?

Yes. Long-term use of uric acid-lowering drugs (such as allopurinol or febuxostat) may affect liver and kidney functions. Blood tests should be performed every 3-6 months to monitor these functions. Patients with a history of renal impairment may require dose adjustments or alternative treatments.

Can weather changes, such as cooling or humidity variations, trigger gout attacks?

Climate changes can indeed trigger gout attacks, as cold environments promote uric acid crystallization. Humid and cold conditions may cause surrounding tissues to contract, worsening pain. Maintain a suitable indoor temperature, use heaters or warm clothing, and continue regular medication to stabilize blood uric acid levels.