Symptoms of acute gout attackThe gout attack occurs predominantly at night and in the early morning hours (2.4 times more often than during the day).Arthritis urica (uric acid gout) is usually monoarticular (affects only one joint). It is a painful monarthritis that occurs within a day without prodromi (“precursors”). Recurrences may occur during the following nights. Furthermore, it is possible that several joints are affected in succession.Arthritis urica is usually the indicator of gout disease (prevalence/frequency in a general practice: 1.5%).
Joint
- Monoarthritis (inflammation of one joint; 90% of cases).
- Podagra (severe joint pain in the metatarsophalangeal joint of the big toe; >60% of cases of monoarthritis) or involvement of a peripheral joint (metatarsophalangeal joint of the thumb; this form of gout is also called chiragra); other joints commonly affected are the knee and ankle joints
Note: Older patients are clustered polyarthritides (inflammation of multiple joints).
- Reddened
- Overheated
- Strongly swollen
- Severe pain – mostly occurring abruptly
- Severe pain to the touch
- Restricted function
The typical features of inflammation (inflammation) hereby appear: Rubor (redness), Calor (hyperthermia), Tumor (swelling), dolor (pain) and Funktio laesa (impaired function).
General signs of inflammation
- Fever (rare) – rather just shivering, mild fever.
- Headache (rare)
- Vomiting (rare)
- Tachycardia (heartbeat too fast: > 100 beats per minute) (rare).
Usually, the symptomatology subsides after 7-10 days even without therapy, often leaving scaling and skin itching over the affected joint.
In women over 65 years, the middle and end joints of the fingers are also often affected, and acute gout attack in the lower extremities is less common here.
Score used to estimate the likelihood of the presence of gouty arthritis.
| Characteristics | Points |
| Male gender | 2 |
| Previous arthritis attacks (reported by patient). | 2 |
| Occurrence within 24 hours | 0,5 |
| Redness of the affected joint | 1 |
| Involvement of the metatarsophalangeal joint of the big toe | 2,5 |
| Arterial hypertension or ≥ 1 cardiovascular disease. | 1,5 |
| Serum hyperuricemia (> 5.88 mg/dl) | 3,5 |
| Maximum score | 13 |
Interpretation:
- Value of ≥ 8 points: positive predictive value of 0.87 (presence of gouty arthritis).
- Value of ≤ 4 points: negative predictive value of 0.95 (exclusion of gouty arthritis).
Symptoms of chronic gout
- Tophi – gouty nodules of uric acid crystals – in the joints and soft tissues – predilection sites (body regions where the disease occurs preferentially) are: Auricle / ear cartilage (as “gout beads”), eyelids, nostrils, bursa, extensor sides of the elbow joints.
- Uric acid crystal deposits in joints
- Joint deformities
- Arthralgia (joint pain) – especially during/after exercise.
- Pruritus – deposition of uric acid in the skin.
- Bursitis (bursitis)
- Tendovaginitis (inflammation of the tendon sheath)
- Swelling of the parotid gland (parotid gland).
- Crystalline keratopathy (disease of the cornea of the eye) – as a corneal manifestation.
- Renal insufficiency (kidney weakness).
- Nephrolithiasis (kidney stones)
