An acute attack of gout is often so typical that the diagnosis is obvious. The onset is often extremely rapid and may reach its worst within an hour or two. One obvious gout joint symptom is the local signs of inflammation in the form of pain, swelling, redness and tenderness. The bunion joint of the foot is involved in half of the first attacks. 99% of first attacks involve only one joint and usually this is a peripheral (distal) joint, such as those of the toes and feet.
The duration of the attack depends on its severity, with a mild attack settling in a few days but a severe attack persisting for several weeks. Taking anti-inflammatory medication early in the attack will often reduce its duration. As the attack subsides, the joint gradually returns completely to its normal state and a complete remission of joint inflammation occurs - very characteristic of gout joint symptoms.
Recurrent acute gout
After an initial acute attack of gout subsides, further attacks are likely to occur, usually after a long interval without symptoms. The second attack may not occur for one of two years but will almost certainly happen if the causative factors continue. Recurrences may involve either the same of a different joint. In such a case, the gout joint symptoms are similar to the acute gout attack, such as sudden onset and local inflammation of the joints. After subsidence, a further attack is again likely to occur, but the interval between attacks usually becomes shorter as more acute attacks occur. Other joint symptoms of gout will start to show up on the tip of the elbow between the tendons around the knee, or the Achilles tendon (behind the heel).
Chronic Gout
As more attacks of acute gout occur, remission is likely to be incomplete. At this stage, the following joint symptoms will be observed - urate crystal deposits within the joints are likely to damage the cartilage lining of the joints, interfering with joint function and minimizing the opportunity for repair between acute attacks. By this time, the patient may be in a state of recurrent acute attacks with very little in the way of remissions. In such a situation, inflammation may only be controlled by the constant consumption of anti-inflammatory drugs which limit the response of the inflammatory cells to the crystals. While this may control some joint symptoms, there remains the risk of an extremely severe attack involving many joints (polyarticular gout) unless the underlying cause of the attack is corrected.
