CreakyJoints discusses how gout develops and progresses throughout its four stages, and ways to prevent symptoms, long-term complications, and lower uric acid levels according to experts.

CreakyJoints spoke to Theodore R. Fields, MD, FACP, rheumatologist at HSS, who explained the lack of symptoms during the first stage. “In this first stage of gout, the person has no joint pain, no red or swollen joints, just an elevated uric acid blood test,” said Dr. Fields. “This is the time that the uric acid, or urate, crystals are collecting in the joints and can cause inflammation later on,” he added.

In the second stage, otherwise known as acute gout, an unexpected attack might occur. “This is when the person has pain, redness, and swelling of a joint, most commonly in the big toe, the foot, the ankle or the knee, but gout can start in other joints as well,” cited Dr. Fields. “This is when the urate crystals are released into the joint fluid and cause an inflammatory reaction, bringing in many white blood cells and releasing inflammatory chemicals that cause the pain, redness, and swelling.”

Additionally, 75 percent of people will experience a second flare within a year, however some can go years before another attack. Dr. Fields cited this third, or in-between stage is where a person has had a gout flare but is presently not having any joint pain or swelling. “Almost all gout patients will go through this phase, since it is the nature of gout to have flares and then quiet down for a period of time before the next flare.”

The fourth stage is called “tophaceous gout” as uric acid deposits can form nodules called “tophi” develop at the big toe or at the elbow. “This stage is where a person can have some joint pain from gout just about all the time,” said Dr. Fields. “It usually takes many years of uncontrolled gout for someone to get into this stage,” he added.

“Anything that makes urate levels go suddenly up or down can set off gout,” said Dr. Fields. Factors include eating a diet high in purines (i.e., red meat and shell fish), alcohol, obesity, emotional or physical trauma. However, weight loss, diet and exercise, medications to limit the amount of uric acid the body produces, and treatments to calm gout flares, can aid with progression.

Dr. Fields concluded, “Treatments for gout are extremely good, and the vast majority of gout patients can expect to be ‘cured. ‘Cured’ is in quotes since it means that gout flares can completely disappear, but the person would need to stay on their medicine.”

Read the article at Creakyjoints.org.