4 Stages of Gout: Which Stage Are You In?

Gout is an inflammatory disease that develops when uric acid levels are too high. Uric acid is a typical result of metabolic reactions in your body, but when levels of uric acid become too high, your body finds it difficult to dissolve and expel it through the urine.

Uric acid begins to crystallize at this point. Uric acid crystals build up in the joints, causing significant discomfort. Gout attacks are most commonly seen in the big toe, however, the disease may affect every joint in the body.

Gout has been divided into four stages by medical professionals to show how the disease might progress over time:

  1. Asymptomatic Gout
  2. Acute Gout or Acute Gouty Arthritis
  3. Intercritical Gout or Interval Gout
  4. Chronic Gout or Chronic Tophaceous Gout

Here’s what to expect at each stage of the disease, as well as how to keep gout from worsening in the first place.

The first stage

The first stage is what they call Asymptomatic Gout. This is the point at which a person gets hyperuricemia or elevated uric acid levels in the blood. Even though the body grows increasingly acidic, there are no symptoms.

A person experiencing the first stage of gout has no joint pain, no red or swollen joints, and only an increased uric acid blood test, according to Dr. Theodore R. Fields, MD, FACP, a rheumatologist at Hospital for Special Surgery (HSS). Uric acid, or urate, crystals are forming in the joints at this time, which may lead to inflammation later.

Uric acid is produced when your body breaks down purines, which are naturally produced in your body and can also be found in some foods and beverages. While high-purine foods may raise uric acid levels, many experts believe that the importance of diet in the development of gout is exaggerated.

At this stage, the uric acid crystallizes and silently accumulates in the joint. Treatment is not required at this stage and no medication is required. However, if a blood test reveals that you have hyperuricemia, you should consider making a significant change in your diet.

NutriGout Dietary Supplement for Gout

 

The second stage

The second stage is the very first gout attack. What they call Acute Gout or Acute Gouty Arthritis. Yes, the first time is shocking and painfully painful, resulting in acute inflammation and joint pain.

Gout’s first painful flare-up might be a rude awakening. However, while it may appear to have appeared out of nowhere, it did not. Your uric acid levels were already rising before you had your first gout attack.

Your food choices were most likely to blame for the triggering of your symptoms, even if you didn’t realize it. Consider those late-night drinking sessions, rich seafood meals, organ meat platters, or even those seemingly harmless ice-cold Coke cans. If you have gout, your eating habits are probably very similar to what we just described.

Even stress or the presence of another illness may cause it too! The pain will escalate over the next 8 to 12 hours making walking very difficult. Generally, this gout attack will be in the big toe area and will feel like a broken foot. The inflamed area will be reddish, and you may experience a slight fever or even chills.

After three days, you should feel better, although symptoms may last up to ten days, and sometimes much longer. These attacks may then become more severe and prolonged if nothing is done about them. The next acute attack may take months or more than a year to reoccur. Over time, however, attacks may last longer and occur more frequently.

Disease progression of gout

The third stage

Next up is the third stage, what they call Intercritical Gout or Interval Gout. This is the period in between gout attacks where you feel no symptoms and your joints function properly. Life is great and you feel great, but everything is just an illusion! For most gout sufferers, uric acid in the blood remains high and the crystals remain in the joint.

This is a stage that almost all gout patients will go through. This is due to the nature of gout, which causes flares followed by a period of quiet before the next flare. The truth is gout hasn’t gone away and the low levels of inflammation between attacks may be causing you joint damage even if you feel no symptoms or pain. In addition, a low level of inflammation could be associated with the risk of developing heart disease or even a stroke!

Although nothing appears to be occurring, this is the time for patients to start long-term treatment. Gout flares and the long-term consequences that come with them may be avoided by lowering uric acid levels with medication.

These delayed attacks may be far more threatening than the initial attack. In addition, they will move to different joint areas such as the Achilles area. It is essential to seek proper medical treatment for the disease. To avoid and/or prevent future gout attacks, you’ll need to adjust your lifestyle by eating well and exercising often.

The fourth stage

Finally, we end it with the final and fourth stage, what they call Chronic Gout or Chronic Tophaceous Gout. Gouty joint pain might be present almost all of the time at this stage. This stage is frequently reached after a long period of uncontrolled gout.

This is the stage which you will want to avoid at all costs. Gout becomes crippling at this point, and it occurs after years of pain. This has been linked to irreversible damage to the damaged joints, renal disease, and even death!

Over time gout attacks become longer and more frequent. This is the worst and most destructive stage because you may develop tophi. The damaged bone and cartilage may be destroyed as a result of this.

This stage usually occurs after about 10 years if the disease hasn’t been treated properly and no lifestyle changes were implemented. With proper treatment, however, most gout sufferers do not progress to this stage, and thank goodness for that! You must treat gout in the earlier stages.

You have the chance to make significant behavioral changes and enhance your health in a way that reduces the risk of another attack.

How to Tell If Your Gout Is Getting Worse

You may be able to detect the onset of a gout attack as you get more familiar with gout symptoms. During an attack, worsening pain, edema, redness, and warmth of the afflicted joint are signs that the attack is progressing.

Furthermore, with repeated or more frequent gout bouts lasting longer, involving more joints, and the presence of tophi, the condition may worsen overall. If you have more than one gout flare-up per year, you must begin taking regular gout medication.

Be mindful of what you eat

A high level of uric acid in your blood causes gout. It causes a flare when it builds up in your joints. It’s critical to avoid meals that raise your uric acid level if you want to reduce your chances of developing gout symptoms.

Maintaining a well-balanced, low-uric-acid diet is essential for preventing gout attacks. Find out which foods and drinks you should consume and which you should avoid.

Foods to cut back on

These are typical “daily” meals that should be consumed in moderation (or avoided entirely in some cases):

  • Red meat: Red meats, such as beef and venison, have more purines than white meats and should be consumed in moderation. Organ meats, such as liver and tongue, are rich in purines and may increase uric acid levels, triggering a gout attack.
  • Seafood: Although seafood is generally seen as a gout-inducing food type, not all of it is necessarily bad for you. For example, anchovies, shellfish, sardines, and tuna are higher in purines than other types of seafood.However, for people with gout, the overall health benefits of eating fish may outweigh the risks. Moderate amounts of fish can be included in a gout diet.
  • Meals high in fat: Beer and distilled spirits have been linked to a higher incidence of gout and recurrent bouts. Wine consumption in moderation does not appear to raise the risk of gout attacks. During gout attacks, avoid alcohol, and restrict alcohol, especially beer, between attacks. 
  • Alcohol: Beer and distilled spirits have been linked to an increased risk of gout and recurrent attacks. Moderate wine consumption does not appear to increase the risk of gout attacks. Avoid alcohol during gout attacks and limit alcohol, particularly beer, between attacks. 
  • Sugary foods and drinks: Sugar-sweetened foods, such as sweetened cereals, baked goods, and candies, should be limited or eliminated. Fruit juices that are naturally sweet should be consumed in moderation.

Gout-friendly meals

  • High-purine vegetables: Just because a certain type of food is high in purines doesn’t make it a food to avoid. Purine-rich vegetables, such as asparagus and spinach, have been shown in studies not to increase the risk of gout or recurring gout attacks.Therefore, eat as much as you like of these purine-rich veggies, and enjoy the chock full of benefits they may provide to your body.
  • Vitamin C: Vitamin C may aid in the reduction of uric acid levels. Consult your doctor to see if a 500-milligram vitamin C supplement is appropriate for your diet and medication regimen.
  • Coffee: According to several studies, consuming coffee in moderation, especially regular caffeinated coffee, may lower the incidence of gout. If you have any other medical conditions, you should avoid drinking coffee. Consult your doctor to determine the appropriate amount of coffee for you. 
  • Cherries: There is some evidence that cherry consumption is linked to a lower risk of gout episodes. Cherries have anti-inflammatory and antioxidant effects. That’s why many gout sufferers may turn to cherry juice to relieve their symptoms and prevent flare-ups.

No, we’re more than aware that eliminating popular foods like beer and steak from one’s diet is much easier said than done. However, you may not need to eliminate them. Instead, in the vast majority of cases, simply limiting your intake may suffice.

The truth is that some people can eat steak but cannot eat crab. Some people can drink beer without issue, while others cannot. You must identify your triggers.

Know your medications well

You must know the names of your medicines and be familiar with the key aspects of how they work. Some medicines, for example, may have serious side effects when combined with particular foods, other medications, or even nutritional supplements. Take the time to educate yourself about the treatment that has been prescribed for you.

Your doctor may have already given you medication. These are the two main types:

  1. Short-term medication to treat flare-ups: When you have an attack, drugs like colchicine (Colcrys, Mitigare) and nonsteroidal anti-inflammatory drugs (NSAIDs) can help with the pain. Steroid pills or shots may also be prescribed by your doctor.
  2. Long-term uric acid-lowering medication: Allopurinol (Aloprim, Lopurin, Zyloprim), febuxostat (Uloric), lesinurad (Zurampic), pegloticase (Krystexxa), probenecid (Probalan), and rasburicase (Elitek) are daily medications that can help treat the underlying cause of gout.

To see how short-term medicine and lifestyle changes improve your symptoms, your doctor will most likely begin by prescribing them. However, most people will require daily long-term medication in the long run.

Make certain you understand what each of your medications does and when you should take them. If you do need long-term medication, make sure you don’t miss any doses. This may cause the level of uric acid in your blood to fluctuate, resulting in a flare.

Start treating your gout symptoms TODAY!

Gout, according to some rheumatologists, may be cured. However, the medical community is unanimous in its belief that there is currently no cure for gout. Having said that, it is, fortunately, one of the most treatable forms of arthritis today.

However, far too many gout patients go untreated or undertreated. In one recent study, for example, only 37% of gout patients were taking the uric acid-lowering medication allopurinol; only half of the patients with gout that suffered from frequent flares were taking it.

Gout is commonly referred to as a progressive disease, which means that it worsens over time. When gout is not properly treated, its progression tends to become more severe over time. Gout may eventually progress to the point where it affects more joints throughout the body. This is when it may cause issues such as gout tophi and permanent bone damage.

Gout treatments are excellent, and the vast majority of gout sufferers can expect to be “cured.” That is, gout flares can go away altogether, but the person must continue to take their medication.

If you suspect you’re having a gout attack, consult your general care physician or a rheumatologist to begin treatment. Seeing a doctor during a gout flare is vital because your doctor may want to extract fluid from the affected joint and examine it under a microscope for uric acid crystals. The presence of uric acid crystals in joint fluid aids in the confirmation of a gout diagnosis.

Posted by Spiro Koulouris

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    7 replies to "Stages of Gout"

    • Daniel

      Hi Spiro,

      I’m on my second, I’d say, flare up. I’ve had a few small ones that would last a day or two that I really should have paid attention to but just thought I was lucky and moved on with my day. Well here I am hating life wanting to rip my toe off. I have done some research and read a lot of your articles but I still cannot get past this pain.

      It’s been about 8 days now but starting the 2nd or 3rd day I began doing most of the recommended things to reduce my uric acid levels. About 3 cups or black or tart cherry juice a day, 1000mg celery seed extract 2x a day, 400mg magnesium a day, nettle and my prescription of 100mg alpurinol a day. All of this and it only seems the sweeling and pain is getting worse.

      I am at a loss, I don’t know what to do. I work on my feet and can’t afford to take time off but I can barely walk. What else can I do? I don’t see my doc for another 12 days and had to plead just to be put back on my meds because I hadn’t filled the prescription in so long. Any further advice would be appreciated.

      Thank you

      • Spiro Koulouris

        Hi Daniel!

        When suffering from a gout attack, natural remedies don’t work as fast, they take longer to help compared to medication. You can try our inflammation cream that we sell on the store and is very popular, you apply it up to 4 times a day to help remove some swelling and make walking bearable. Try soaking your feet in warm water twice a day with Epsom salt to relax the muscles. Drink at least 12 cups of water daily to flush out excess uric acid. You can also take some ibuprofen, takes some pain away, again making walking more bearable. As gout sufferers we’ve all been there.

        Good luck!

    • […] What are the different stages of gout? […]

    • Bev

      Hi Spiro

      I m 67, female and got blindsided by gout last summer. I m vegetarian and was working on reducing my weight ( got from 220ish to 180ish), drank a couple of Molsons 67 ( 3%) a day when one day last summer I thought I broke my toe, just as you describe. Went into full panic and research mode, like you and found such conflicting information I was hysterical for a while, especially about purines in veggies. I had a severe fever and was extremely emotional which seems shocking now. My doctor means well but isnt much help. I dont want another of those attacks ever!

      Back then I ate the odd lobster or tuna but now stick to veggies. And a bit of butter and cheese though if I have another attack they ll go too. Still trying to lose weight but avoiding extremes; make lots of salads with home made ginger dressings, drink apple cider vinegar water several times a day and cherry juice, indulged a bit in sweets over the holidays but havent had a coke in decades; no glucose/fructose. Am frightened by the aging issues and inflammation which I had no idea about before this. Do have high blood pressure thankfully treated and am trying to avoid cholesterol meds.

      The experts apparently don t know much about this ancient condition and the blogs are few and far between. Your blog is consistently the best and I want to say a heartfelt thank you. Also great that you re Canadian too! However you are also a young man and I d be interested in learning how other older women manage as there seem to be few of us and there may well be gender differences. I cant read comments on your entries; do I need to do something more than subscribe which I do?

      Again thank you for sharing this precious resource you ve created! I m so happy every time your newsletter appears! Keep it up and I ll nominate you for a national award. Cant believe there s so little research on this destructive disease!

      • Spiro Koulouris

        Thank you for the kind words and feedback!! Yes alcohol is a common villain in triggering gout attacks, so stay off it. Avoid lobster completely, that’s what I do, I don’t eat any shellfish anymore and if you do, eat it at your own risk. As for more information concerning women and gout, please read my post on that topic–> https://goutandyou.com/gout-and-women/ . Do note that women represent a much smaller segment of gout sufferers since the vast majority are men so there is less information on women and gout compared to men.

    • […] The 4 stages of gout […]

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