Gout is a common form of arthritis that usually affects the joint at the base of the big toe, though it can cause symptoms in the fingers, wrists, elbows, knees, and ankles, as well. Symptoms develop when the levels of uric acid in the blood become too high due to excessive consumption of purines. These chemicals are present in meats and alcohol, as well as other foods, and the kidneys cannot always excrete them quickly enough. As a result, urate crystals accumulate in the affected joint.
For most people with gout, severe pain in the big toe is the first symptom. The buildup of urate crystals in the joint causes this pain and usually affects only one joint at a time, though it can spread to other joints in subsequent flares. The first 36 hours or so are often the most painful. Joint pain from gout usually resolves in about a week to 10 days.
Swelling from gout is usually a result of the inflammation occurring within the affected joint. It is one of the most common and recognizable signs of gout and is felt directly over the affected joint. The onset is usually quick, and the pain and swelling appear around the same time. When experiencing a gout attack, it is helpful if the person removes socks or any pants that are tight around the ankles; this pressure against the swelling limp can cause the pain to increase.
Joint pain, swelling, and redness are the three universal symptoms of gout. Anyone experiencing a gout attack will see redness over the affected joint. This sign is mostly caused by inflammation within the joint. It may also be a result of tissue stretching and swelling and increased blood flow to the area.
The swelling and redness at the affected joint will feel warm or hot to the touch, due to the inflammation within the joint and the surrounding tissues. The temperature seems to radiate out from the joint. Doctors will only diagnose gout is the person is experiencing swelling, pain, redness, and heat, as these are definitive signs of an attack.
Someone experiencing a gout attack has difficulty moving the associated joint. There are a few reasons for this. Not only might the person be in too much pain, but the associated swelling may also prevent the joint from moving as it should. Plus, the uric acid crystals in the joint itself can lead to stiffness.
While the worst of the pain associated with a gout attack usually resolves in a day or two, discomfort can linger in the joint for a few days or weeks, though it should eventually go away. Subsequent attacks may last longer and affect more joints. Depending on severity and frequency, gout can cause chronic pain issues.
With a gout attack, tenderness has characteristics that are separate from pain. As mentioned, intense joint pain is a hallmark of a gout attack. Tenderness has more of an effect on the outside of the joint. For example, someone experiencing a gout flare may not be able to rest a blanket against their knee without experiencing increased pain.
Chronic aches and pains can be a sign that gout is getting worse. Someone who continues to have achy joints weeks or months after a gout attack may be experiencing long-term damage. While not as painful as a flare, the longevity of these dull aches can significantly impact an individual's quality of life.
Dry, peeling skin over the affected joint is a common symptom of gout and usually a result of the inflammation and swelling stretching the tissue and causing damage to the surface layers of the skin. This peeling and dry skin can persist for days after the gout attack resolves.
Tophi are the large deposits of uric acid that accumulate in the joint after subsequent gout attacks. They cause the joint to be permanently disfigured and can greatly affect the quality of life. Tophi do not go away after a gout attack resolves.
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Distinctive qualities of a gout attack are that it usually comes on suddenly, quickly, and at night. A flare can reach its worst point within 12 hours. The person may not have shown any signs of an impending flare during the day and then wake up at night in severe pain.
Gout can cause a range of systemic symptoms, including nausea and loss of appetite. These symptoms may occur right before a flare, during its peak, or as the gout attack is resolving. This is not common but does occur in some people with gout.
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