Gout
Gout is defined as a manifestation of hyperuricemia with various symptoms. The development of a symptomatic gout can be divided into four stages. Not all stages are characterized by symptoms.
Symptomatic stages alternate with acute forms.
- The first stage of gout is clinically unremarkable. Hyperuricemia is present in the laboratory alone.
Its duration can be between five and ten years.
- In the second stage the gout becomes symptomatic for the first time by an acute attack of gout. This is accompanied by severe joint pain and usually occurs at night. It is often observed as a result of a sumptuous, purine-rich meal.
The metatarsophalangeal joint of the big toe is the most common site of manifestation.
- The third stage is also known as the intermediary stage. It is the period between two acute attacks of gout. It is characterized by freedom from symptoms and can last between six months and two years. In a proportion of those affected, about eight percent, no new seizures are observed.
- The fourth stage describes the chronic course of gout with typical manifestations. These include degenerative joint changes and the appearance of characteristic nodules, so-called tophie, on bones and soft tissue.
Podogram
Podagra describes the acute attack of gout at the metatarsophalangeal joint of the big toe. In more than half of the cases the first attack of gout occurs at this joint. Those affected complain of sudden, severe pain, which occurs mainly at night.
The joint is swollen, the skin feels warm and is reddish in color. It is an arthritis, an acute inflammation of the metatarsophalangeal joint of the big toe. There is a close connection between the location and the occurrence of the first acute attack of gout.
Joints that are furthest away from the warm center of the body have a lower temperature. An increased uric acid level in the blood, changes in the pH value and a lower temperature in the peripheral joints promote the precipitation of urate crystals.