Gout symptoms and foot pain appear to occur suddenly (without much warning), most often at night. Studies have shown that hormonal shifts during the night, combined with lower body temperature, a nocturnal dip in cortisol (steroid hormone) levels and night-time dehydration contribute to body conditions that make one twice as likely to experience an acute (severe) gout attack. Attacks also typically stop as (seemingly) spontaneously as they began, but discomforting effects can linger for some time.
Symptoms characteristic of gout include:
- Acute joint pain: Discomfort is intense and most commonly affects the large joint of the big toe (known as podagra), but can also occur in the feet, ankles, knees, wrists and hands. Pain is most intense or severe between 4 and 12 hours after a gout attack occurs. Pain, at its worst, is so acute that any contact with the affected area (even a light bed sheet) can cause severe, often unbearable discomfort.
- Lingering discomfort: Once the worst of the pain subsides, discomfort in the joint typically lasts for between several days to a week or two. Discomfort from recurrent attacks can sometimes last for longer and affect other joints.
- Tenderness, swelling, inflammation and redness: The affected joint will become swollen (due to joint effusion – fluid build-up in the joint), stiff, tender to the touch, feel warm / hot and take on a pink / red colour.
- Reduced or limited range of motion: Inflammation and pain can lead to decreased mobility.
Stages of gout
Progressive in nature, gout occurs in 4 stages:
- Asymptomatic hyperuricemia (excess uric acid in the blood – symptoms are not normally present at this stage)
- Acute gout (hyperuricemia causes the formation of uric acid crystals within a joint – the onset of symptoms is sudden)
- Interval or inter-critical gout (this refers to the period between severe / acutely painful gout attacks)
- Chronic tophaceous gout (this refers to gout that is left untreated, uric acid levels remain elevated for an extended period of time and hard nodules called tophi begin to develop on the joints and surrounding soft tissues [beneath the skin and are not normally painful], and can be seen and felt externally – these result in permanent damage to the joints and surrounding tissues / tendons)
Gout attacks should ideally not be ignored and left untreated. Chances are one attack may lead to another. Yes, pain and inflammation can resolve completely on their own, but subsequent attacks can affect the same joints (or multiple joints) again in time, sometimes at the same time. Recurrent gout flares can worsen symptoms of pain and cause damage (often irreversible) to the joints (like loss of cartilage), tendons and surrounding tissues. Gout attacks can also happen more frequently if left untreated, with painful episodes lasting longer than the previous experience. Physical deformity can also occur when left untreated for prolonged periods of time.
If ever symptoms are experienced along with a fever, it could be a sign of an infection and the sufferer must be evaluated and treated by a medical doctor as soon as possible. Untreated, gout can also make a person more prone to developing kidney stones.
Who to see if you suspect you have gout
- General practitioner (GP) / primary care physician / family medicine physicians
- Internists
- Emergency personnel (hospital)
- Rheumatologist (specialist in conditions such as arthritis and gout)
- Orthopaedists
- Nephrologist (specialist in kidney / renal care)