Stages of Gout

Gout develops in recognisable stages. Not everyone with high uric acid moves through all of them.

Stage 1: Asymptomatic hyperuricaemia

Uric acid is high, but there is no pain. Crystals may be silently forming. Most people at this stage never develop gout, and drug treatment is usually not needed. Lifestyle change and checking for causes are advised.

Stage 2: Acute gout flare

A sudden painful attack with a hot, red, swollen joint. It usually settles in a week or so with treatment.

Stage 3: Intercritical period

A symptom-free time between flares. Crystals remain in the joint and the next flare may come in months or years. This is the best time to start long-term treatment if advised.

Stage 4: Chronic tophaceous gout

After years of untreated high uric acid, chalky lumps (tophi) form under the skin and around joints. Joint damage, persistent pain and reduced movement can follow. Kidney problems and stones may occur.

Changing the course

Lowering uric acid below the target set by your doctor, usually under 6 mg/dL, dissolves crystals over time and prevents flares and damage.

Key point

Early treatment prevents progression. A first attack is a good time to review causes, kidney health, diet and long-term options with a doctor.

Before your appointment

Carry earlier uric acid and kidney reports, a list of all medicines and supplements, and notes on which joints hurt, when flares started and what you ate or drank beforehand. Tell your doctor about any kidney stones, diabetes, blood pressure or family history of gout.