There are four clinical phases of gout: asymptomatic gout, acute gout, intercritical gout, and chronic tophaceous gout. Asymptomatic gout, otherwise known as asymptomatic hyperuricemia, is the first phase of the disease and is characterized by hyperuricemia, which is the silent buildup of uric acid in the blood. That said, not everyone with elevated levels of uric acid in their body will develop gout. Furthermore, asymptomatic hyperuricemia is associated with a number of disorders that are unrelated to uric acid crystal deposition, such as hypertension, chronic kidney disease, cardiovascular disease, and insulin resistance syndrome. Despite the fact that the body is becoming increasingly acidic during this phase, there are no noticeable signs or symptoms of the disease. Therefore, neither treatment nor medication are required for asymptomatic gout, although an immediate change in diet is advisable.
The second phase of gout, otherwise known as acute gout or acute gout arthritis, is the phase in which the first gout attack occurs. These attacks typically strike in the middle of the night or in the early hours of the morning, and often appear with little to no warning. The pain that accompanies the attack is described as excruciating and can last anywhere from 4 to 12 hours. During an attack, the affected site will appear reddish in color and the sufferer may experience a slight fever or chills, but symptoms generally subside in 3 to 10 days. These gout attacks most often occur in the first metatarsal joint of the foot, also known as the base of the big toe, and are given the name podagra. If left untreated, symptoms increase in duration and severity from one gout attack to the next.
Intercritical gout, also known as interval gout, is the third phase of the disease and refers to a period between two acute attacks in which no symptoms are present. These intervals are called intercritical periods and during this time, the joints function properly and the sufferer experiences no pain. Although the disease is not visibly active in this phase, research suggests that the cartilage and bone of the affected joint may still be deteriorating. Essentially, intercritical gout presents itself very similarly to asymptomatic gout, the main difference being that a gout attack must already have occurred for a phase to be labeled as intercritical gout.
The fourth and final phase of gout is known as chronic tophaceous gout, a type of arthritis with joint tissue destruction and permanent joint deformity. This phase occurs only after many years of suffering. If the disease progresses to this phase, a number of complications can occur, sometimes even death. One of the most common complications is tophi, or permanent uric acid deposits which form along the bones, just beneath the skin. Sufferers are also at an increased risk of kidney stones and urate nephropathy, or the formation of crystals in the interstitium of the kidney. Given these potential complications and the fact that chronic tophaceous gout is most often preventable with proper management and treatment, it is important to seek remedies for gout as soon as any symptoms occur.
Resources:
- https://healthguides.healthgrades.com/article/the-4-stages-of-gout
- https://www.aafp.org/afp/1999/0401/p1799.html