Symptoms and Complications
The symptoms of a gout attack are almost unmistakeable. Typically, a
person will go to bed feeling fine, then wake up during the night with intense
pain in the big toe (three-quarters of gout cases involve this joint). At first
it feels like a bucket of cold water has been poured over the joint, but soon
there's an agonizing sensation of stretching and tearing, along with pressure
and tightness. The affected area also becomes extremely sensitive to touch -
even a bed sheet or someone walking in the room makes it hurt more. The swelling
often spreads over the whole foot, making it impossible to put on a shoe. Also,
low-grade fever may develop.
An attack will usually taper off on its own in 3 to 10 days, but prompt treatment
can end it faster. After such an attack, called acute gout or acute gouty
arthritis, over half of sufferers will have another episode within the next
year. Attacks tend to strike more often, last longer, and affect more joints
over time.
In some people, however, the attacks don't go away - instead, they linger on
to become chronic gout. The inflammation persists, while the crystals
can permanently damage and deform the affected joints. As well, uric acid crystals
can build up in tissues other than the joints, forming deposits called tophi
that can show up as whitish or yellowish chalky lumps under the skin, typically
in the fingers, toes, back of the elbow, behind the heel, and around the outer
edge of the ear. The tophi sometimes poke through the skin, leading to ulcerations
or sores.