The signs and symptoms of gout are often sudden and unexpected, and typically strike in the middle of the night or very early in the morning. The large joint of the big toe is by far the most common site of the disease, but gout can also occur in the ankles, knees, elbows, wrists, fingers, heels, insteps, and any other joint in the body. The first sign of a gout attack is an intense and excruciating pain in the affected joint, reaching its peak 4 to 12 hours after onset. The pain will then lessen, but some joint discomfort will remain for up to 10 days. Following the first gout attack, subsequent attacks usually last longer, affect a greater number of joints, and potentially cause permanent damage. That said, both the pain and inflammation associated with gout attacks will disappear completely during the period between two attacks.
The affected joint or joints will appear red and swollen, in addition to feeling tender and warm to the touch. Some sufferers describe the pain as having a broken foot or feeling like their foot is on fire, and the lightest touch to the joint can be excruciating, even the weight of bed sheets can produce pain. As the disease progresses from acute gout to chronic gout, the sufferer will experience limited range of motion and struggle to move his or her joints normally. When gout improves, the skin around the affected joints can become itchy or start to peel. On the other hand, in the event that gout is left untreated, the disease will begin to affect other parts of the body, besides just the joints. For example, tophi may develop, kidney stones may form, and bursitis may occur.
Tophi are painless but disfiguring deposits of uric acid crystals, which develop beneath the skin and around the joints. These hard nodules, or lumps of abnormal tissue, flare up and become painful during a gout attack. In some cases, the tophi erode through the skin and a white chalky substance oozes out. Additionally, the build up of tophi in the joints can lead to permanent kidney damage. In the same way that urate crystals can build up under the skin, they can also build up in the kidneys. When this happens, kidney stones may form, which can then affect the kidney’s ability to filter waste products out of the bloodstream.
Another serious complication of gout is bursitis, a painful condition accompanied by stiffness and swelling that affects the fluid-filled sac known as the bursa. This sac is responsible for cushioning the bones, tendons, and muscles near the joints, specifically those found in the elbows and knees. Bursitis occurs when the bursa becomes inflamed, and this inflammation increases the risk of infection. Signs of infection range from worsening redness of the affected site to warmth around the joints to a fever, all of which can lead to permanent joint damage. Most often, the pain associated with bursitis will subside within a few weeks, but recurrent flare ups are not uncommon.