Gout occurs mainly in middle-aged men, who represent 90% of all gout sufferers. Often they are obese and suffer from high blood pressure (hypertension). The remainder are usually post-menopausal women; gout is rare in children.
Signs and symptoms include the following:
Acute gouty arthritis
• Sudden onset of intense pain in a joint, typically the big toe, sometimes also the ankle, knee, elbow or wrist.
• The onset can be almost immediate, or over minutes to hours.
• Swelling, inflammation and a feeling that the joint is very hot.
• Tense, warm, shiny red or purplish overlying skin.
• Occasionally, in extreme cases, chills and fever.
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Although susceptibility to gout is probably something one is born with, the first attack of gouty arthritis usually does not appear until middle age, mainly in men. The first few attacks may come (often at night) and go without apparent reason, but are often precipitated by the factors above. The symptoms usually settle down within days.
With prompt treatment, the pain and inflammation can be brought under control quickly, although attacks can recur if the underlying problem, a high urate level, is not treated. Later untreated attacks may persist for weeks or even become chronic with daily pain.
Chronic joint symptoms
• Asymptomatic intervals tend to become shorter as the disease progresses. Attacks start to occur more frequently and may start to develop in more than one joint and in unusual sites including knees, hands and elbows.
• Joints can become permanently deformed as a result of erosion by the crystals, so that hands and feet lose their mobility. In rare cases, the shoulder, chest joints or neck vertebrae may be involved.
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When gout has been present for a longer period, urate deposits called “tophi” develop. They appear as small, hard lumps around ankles, hands, the tips of the elbows, earlobes and even around the vocal chords and the spinal cord.
• Eventually they can cause pain or stiffness.
• They can also protrude and finally erupt, causing a discharge of chalky material, containing urate crystals.
• Neglected tophi cause damage to the underlying bone and joints and are an absolute indication to treat the underlying condition and not just the symptoms of the attacks.
Causes of Gout
Treatment of Gout
Previously reviewed byDr David Gotlieb, rheumatologist, MBChB FCP(SA), September 2004
Reviewed by Dr Ingrid Louw, rheumatologist, MBChB, MMED Int Med, (private practice), August 2011