The term used to described the periods between attacks is the intercritical gout. The first attach is fallowed by a complete remission of symptoms which left and treated they will appear at same point in the future. One recent study has indicated that 62% of subjects experienced one further attack within a year. After two years 78% of patients experience a recurrence and after 10 years 93 % of them had had repeat attacks.



An untreated gout can be sometimes less intense or it can last longer. About 10 to 20 years gout becomes a chronic disorder characterized by constant low grade pain and mild or acute inflammation. Several joints including that may have been free of symptoms are generated also by gout. Sometimes the shoulders, hips or spine are affected. The crystal deposits (symptoms of Tophi) that form during chronic gout generally form in the following deposits: helix of the outer ear, forearms, elbow or knee, hands of feet, and rarely they can settle in regions around the heart and spine.

But they can often cause pain and stiffness in the affected joint. They can also erode cartilage and bone and at last destroying the joint. A large tophi under the skin of the hands and feet can rise the extreme deformities. Symtoms may be influenced by various conditions: severe illness because gout can be accompanied by serious conditions associated with kidney and heart diseases including diabetes, obesity, unhealthy cholesterol levels, insulin resistance, and high blood pressure, stress, infection, joint injury, weight loss, surgery, certain drug treatment, overindulgence in alcohol or purine rich foods.

These symptoms appear more frequently in the spring, especially in April. Gout can be divided into four symptomatic stages: asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout and chronic tophaceous gout. The stages of gout depends on a persons aged. In middle aged adults symptoms may occur in one joint, moat often in the lower limbs. In this case the first occur is in the big toe. In elderly people symptoms occur in the number of joints in the upper extremities, generally fingers. Asymptomatic hyperuricemia precedes gout and is considered the first step of disorder, it can last till 30 years. Hyperuricemia does not inevitably lead to gout.

Less than 20% hyperuricemic people develops the full-blown arthritic disease. When the first symptoms of the gout appear the acute gout arthritis may occur. Bief twinges of pain in an affected joint may precede the actual full-blown conditions. When concentrations in the blood reach 7 mg per dL MSU crystals form at a normal body temperature because blood temperature falls with distance from the heart, gout strikes the toes and fingers first. The gout arthritis symptoms are described as follows: a severe pain around the joint, described as crushing, resembling as a dislocated bone. The pain in this case is so intense that walking and even the weight of bed sheets can be unbearable.

A writer has described gout as "walking on my eyeballs". The pain lasts about 12 hours. In most cases the attack appears late at night or early in the morning. The indication of fluid build-up is characterized by swelling extended beyond the joint. Persons affected with gout have the skin often red, shiny and tense. An attack of gout can also be accompanied by symptoms like chills and mild fever, loss of appetite and feelings of health. A first condition is called monoarticular gout and the second one is known as polyarticular gout. In the first case refers to the middle-aged adults. This appearance is known as podagra and affects the big toe's metatarsophalangeal joint, the point where one of the long five bones of the foot meets the first digit of a toe.

The second one named polyarticular gout affects older people. The joints of the foot, ankle, knee, wrist, elbow and hand are frequently affected. The pain appears in most cases in the lower extremities. People with polyarticular gout have a gradual onset of pain and a longer delay between attacks. In this case the gout appears in the fingers. People with polyarticular gout experience low-grade fever, loss of appetite and a general feeling of poor health. Untreated attack can last several weeks.

Gout has become a very dangerous disease but it can be curried by various and modern treatments and used medications.