What Happens

Gout usually develops after a number of years of buildup of uric acid crystals in the joints and surrounding tissues. A gout attack usually starts during the night with moderate pain that grows worse. A gout attack typically causes pain, swelling, redness, and warmth (inflammation) in a single joint, most often the big toe. Then symptoms gradually go away.

• Most gout attacks stop after about a week.
• Mild attacks may stop after several hours or last for 1 to 2 days. These attacks are often misdiagnosed as tendinitis or a sprain.
• Severe attacks may last up to several weeks, with soreness lasting for up to 1 month.
• Many people have a second attack of gout within 6 months to 2 years after their first attack. But there may be intervals of many years between attacks. If gout is untreated, the frequency of attacks usually increases with time.

There are three stages of gout.¹ Many people never experience the third stage.

• In the first stage, you have high uric acid levels in your blood, but no symptoms. The uric acid levels may stay the same, and you may never have symptoms. Some people may have kidney stones before having their first attack of gout.
• In the second stage, uric acid crystals begin to form, usually in the big toe. You begin to have gout attacks. After an attack, the affected joint feels normal. The time between attacks may grow shorter. Your later attacks may be more severe, last longer, and involve more than one joint.
• In the third stage, symptoms may never go away. They may affect more than one joint. Gritty nodules called tophi may form under your skin.
  • Without treatment, the tophi may form in the cartilage of the external ear or the tissues around the joint (bursae, ligaments, and tendons). This can cause pain, swelling, redness, and warmth (inflammation). Progressive crippling and destruction of cartilage and bone is possible.
  • This stage of gout is uncommon because of advances in the early treatment of gout.