Symptoms and Diagnosis

Attacks Usually Start at Night

Gout is a form of arthritis that causes sudden onset of intense pain and swelling in the joints, which also may be warm and red. Gout typically attacks one joint at a time, and the attacks usually begin at night.

Where Gout Usually Occurs

Gout normally attacks joints in the lower part of the body, such as the knee, ankle or big toe. For many people, the joints in the big toe are the first to be attacked. In fact, sometime during the course of the disease, many people will develop gout in the big toe.

Other Signs and Symptoms

These can include

  • hyperuricemia -- high levels of uric acid in the body
  • the presence of uric acid crystals in joint fluid
  • more than one attack of acute arthritis
  • arthritis that develops in a day, producing a swollen, red, and warm joint
  • an attack of arthritis in only one joint, often the toe, ankle, or knee.

Diagnosis May Be Difficult

Gout may be difficult for doctors to diagnose because the symptoms can be vague, and gout often mimics other conditions. Although most people with gout have hyperuricemia at some time during the course of their disease, it may not be present during an acute attack. In addition, having hyperuricemia alone does not mean that a person will get gout. In fact, most people with hyperuricemia do not develop the disease.

Testing for Gout

To confirm a diagnosis of gout, the doctor inserts a needle into the inflamed joint and draws a sample of synovial fluid, the substance that lubricates a joint. A laboratory technician places some of the fluid on a slide and looks for monosodium urate crystals under a microscope. If crystals are found in the joint fluid, the person usually has gout.