The Progression Of Gout - Four Stages

The progression of the disease process of gout has many variables. It can mimic other conditions that can make diagnosing gout a challenge to any physician. Surprisingly, not all patients having a gout attack have elevated uric acid levels, and not all people with elevated serum urate levels have a gout attack. A person can have a high uric acid level for years and not have an attack of gout.

To have an understanding of gout's progression, it is important to know it's four stages:

Asymptomatic Hyperuricemia:

Most people with a high uric acid level never have an attack of gout. On the other hand, there are those who have high serum levels and will experience a delay of about 20 years before an attack of gouty arthritis (urolithiasis) occurs. As serum level rise, so do the risks of developing gout.

Acute Gout:

Initial development usually occurs in the first metatarsophalangeal joint of the toe. During an acute attack, the affected joint will have warmth, redness, swelling, and tender to the touch. If an acute gout attack involves two or more joints, fever may also be present. A mild attack may last a few hours, but a severe one can hang on for weeks.

Men may experience their first attack between the ages of 40 and 60. For women, the usual age is around 60. The attacks have a rapid onset usually occurring during the night. However, there may have been some discomfort in the ankles, heels, or big toe before the first attack occurred.

Most initial gout attacks involve only one joint, mainly of the lower extremities, but can involve any joint. Diagnosis is determined by the presence of urate crystals in the synovial fluid of the affected joint.

Intercritical (interval):

This is the period between attacks. After the first gout flare up, the second may not occur for up to two years. Still, other patients won't have a recurrence until after ten years or more. As time passes, later attacks may be more severe and last longer, as well as the progression of joint damage becomes more advanced.

Chronic tophaceous gout:

Undiagnosed hyperuricemia may bring the intervals between attacks closer together until they disappear. This may result in constant joint inflammation, joint deformity, and tophaceous deposits of urate crystals in the soft tissues surrounding the joint. This can also be coupled with periods of acute arthritis.

Tophi are known to show up anywhere, usually, but not always within the same affected joint. The tophaceous deposits are not usually painful, but the site may become inflamed with the end result being pain. Joint damage and large tophi can result in debilitating deformities of the joint with unrelenting pain.

by Barb Hicks, RN