What is Gout?

Gout has literally been around for ages. The first mention of gout in medicine appeared over two thousand years ago. It used to be called “the disease of kings” because people thought it was a result of consuming too much rich food and alcohol.

Unfortunately, gout is still very much with us. In the United States today, an estimated 8 million people have gout. Approximately 3 million have had at least one attack in the past year. This is double the number of cases that existed twenty years ago.

What is gout, exactly? It’s a type of inflammatory arthritis. It’s sometimes called “gouty arthritis.” Gout develops when a person has high levels of uric acid in the blood and the uric acid has been deposited as needle-like crystals in different parts of the body (ouch!).

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So maybe gout isn’t “the disease of kings,” but it can still be a royal pain. Left untreated, it can lead to destruction of joints and some serious health problems. That’s why it’s important to take steps to tackle it.

Stages of Gout


Before the first attack of gout, there are no symptoms. At this stage, blood levels of uric acid are high, and crystals have begun silently accumulating in the joint.


The second stage occurs when something (such as illness or a night of drinking) quickly raises the blood levels of uric acid or jostles the crystals that have formed in the joint. This triggers a surge of inflammation, which causes sudden, severe pain in a joint. This is a gout attack. The attack frequently happens at night, with the pain rapidly intensifying over the next 8 to 12 hours, making walking (or any movement) difficult, or even impossible. Usually the attack begins to ease up after a few days and is fully gone in a week or 10 days, even if not treated. The next acute attack may not happen for months or for more than a year. A small percentage of people never have a second attack.


The third stage describes the time periods between attacks. Everything feels fine and there is no pain. However, for the vast majority of people, blood levels of uric acid remain high, and crystals remain in the joint. Gout hasn’t gone away. In fact, the low levels of inflammation between attacks may be causing joint damage—even while there’s no pain. It’s essential to take steps to tackle gout at this stage (through lifestyle changes and proper medical treatment) to prevent or reduce future attacks and avoid chronic gout


Chronic gout, the final stage, takes years to develop. Over time attacks become longer and more frequent. Eventually the pain continues even between attacks. By this time, there may be loss of mobility due to permanent joint damage. Proper management and treatment can help prevent gout from progressing to this stage.

Where Does Gout Appear in the Body?

The first attack of gout usually affects a single joint of the lower body–about half the time in the big toe, but sometimes the ankle or knee. Attacks typically occur at night, and people wake up with pain in the affected joint. Gout often comes and goes. Attacks are followed by pain-free periods that can last for months, until another attack arrives. Although an initial attack may appear in one joint, later attacks may affect different joints in the lower body, from the feet to the knees, or even upper body joints.

If gout isn’t managed, it can progress to its chronic stage and affect multiple joints simultaneously, in both the lower and upper body, from the feet to the hands. At this stage damage is occurring in the joints and pain is constant. Gout also begins to affect soft tissues too. Lumps of crystals (known as “tophi”) may develop under the skin and appear as nodules on the fingers, elbows and other parts of the body, such as around the outside curve of the ear. Some people develop kidney stones, hard lumps of uric acid that form due to high blood levels of uric acid. It may feel as though gout is taking over your whole life.