Before the first gout attack occurs and the disease is discovered, gout disease often exists for years. The phase in which uric acid levels continue to rise slowly but without symptoms is called the asymptomatic phase. Typical gout symptoms do not become noticeable until the level reaches a critical point and a gout attack occurs.
Pain in the toes
When a gout attack occurs, there is typically severe pain. The joint in the big toe is particularly commonly affected (podagra). In addition to the pain, the joint may be reddish in color and very swollen and overheated. It is also extremely sensitive to touch. In some cases, those affected can only walk on their heel, resulting in a limping gait.
In addition to the toe joint, an attack of gout can also cause discomfort in the thumb joints, the knee joints, the ankle joints and the joints in the midfoot. If the condition is not treated appropriately and lifestyle adjustments are made, chronic pain can result.
Uric acid is deposited in the joints
In gout, pain is caused by uric acid crystals being deposited in the body. Preferably, this occurs in the skin, joints, tendons, ear cartilage, and bursae. As a result of the deposits, painful joint inflammations can then develop.
If the inflammations are not treated, chronic damage to the joints can occur in the long term. Damage to other organs, such as the kidneys, is also possible. The uric acid crystals are also deposited here and over time can lead to kidney stones and, in the worst case, to a functional failure of the kidney.
The deposits of the crystals sometimes cause visible nodules to form. These are called gouty tophi. However, tophi only form when there are large clumps of crystals. Today’s treatment options mean that this is rarely the case – often when gout is not treated.
Chronic course
The first attack of gout usually comes as a complete surprise to those affected. Often, these are healthy people who know nothing about their condition. An acute gout attack can last from several hours to a few days. Once the symptoms have subsided, the gout attack is usually followed by a longer symptom-free phase.
If no therapy is given, however, gout attacks may recur. In most cases, the symptoms worsen over time. In concrete terms, this means that the attacks occur at shorter intervals, last longer and can also spread to other joints.
If the disease takes a chronic course, serious complications can also occur. These include, for example:
- Constant pain
- Chronic inflammation of the joints
- Joint deformities
- Bursitis
- Kidney stones, kidney weakness and kidney failure.
However, chronic gout is relatively rare. It develops only if the disease is not treated or not treated adequately.
Diagnosis of gout
Based on the typical symptoms, the doctor can often already make the suspected diagnosis of gout. A blood test can then determine the current uric acid level in the blood. However, this does not necessarily have to be elevated in the case of a gout attack. Therefore, regular measurement of the values is more meaningful than a one-time test.
In addition to a blood test, a urine sample can also provide further information. This is because while uric acid levels in the blood are usually elevated in gout, they are lower than usual in the urine.
Joint puncture and x-ray
If there is still doubt after the blood test as to whether the patient actually has gout, a joint puncture followed by an examination of the synovial fluid can provide an unambiguous result. Under the microscope, the uric acid crystals in the fluid can be clearly seen.
An X-ray examination, on the other hand, makes little sense in the early stages of the disease. However, if the disease has progressed to an advanced stage, an X-ray can be helpful for diagnosis. This is because visible changes in the joints are then often already present.
