Gout Symptoms and Diagnosis

Acute gout usually involves a single joint, and acute gout symptoms typically go away within several days. People with acute gout may not experience another attack for several months, but recurrent attacks can lead to chronic gout. This is sometimes called recurrent gout or gouty arthritis. Chronic gout may involve more than one joint. (1)

What Does Gout Look Like?

Gout pain is the most common and noticeable symptom of gout.

Many, but not all, people experience their first gout attack or flare-up in their big toe. The pain often starts during the night and comes on suddenly.

The type of pain you feel with gout may vary depending on whether you’re experiencing an acute gout episode or a flare-up of chronic gout.

Signs and Symptoms of Acute Gout

Acute gout pain may include:

Sudden crushing, throbbing, or excruciating pain in one or a few joints (often in the big toe, knee, or ankle) that may last for a few days
Pain that starts during the night (some people say the pain wakes them up)
Joints that feel very tender (it may hurt even to cover them with a sheet or blanket)
Joints that look swollen (the skin may be reddish-purple and feel warm to the touch)

Signs and Symptoms of Chronic Gout

Chronic gout pain may include:

Pain that tends to be a more continuous feeling of dull aching or soreness in the joints
Hard white deposits or lumps under the skin, called tophi, that may swell during a gout attack. They’re often found on the elbows, ears, or fingers. (2)

Other Signs and Symptoms of Gout

Other gout symptoms may include:

Joint stiffness
Fever or chills
Fatigue

Is It Gout, Pseudogout, or Something Else? Conditions Similar to Gout

There are a number of conditions that look a lot like gout and can be confused with or misdiagnosed as gout. (3)

If your gout doesn’t respond to therapy, you may have one of these other conditions:

Pseudogout Like gout, pseudogout is a type of arthritis that happens when painful crystals form in the joints. The makeup of the crystals is different in pseudogout. Gout crystals form from a buildup of uric acid, while pseudogout crystals form from too much calcium. Pseudogout often appears in the knees. (4)
Reactive Arthritis This is a type of joint pain that is triggered by a bacterial infection somewhere else in the body.
Infectious Arthritis This is a painful condition that can happen when bacteria directly infect a joint.
Psoriatic Arthritis About 4 to 6 percent of people with the skin condition psoriasis can get this form of arthritis.
Chronic Rheumatoid Arthritis In this autoimmune disease, the body’s immune system mistakenly attacks its own joints, causing pain, stiffness, and swelling.
Chronic Osteoarthritis Osteoarthritis is the breakdown of cartilage or cushiony tissue between the joints that often occurs with age.

Gout Attacks and Flare-Ups

Gout attacks usually get better on their own within about 3 to 10 days, even without treatment. You may not have another gout attack or flare-up for months or even years.

Some people find that over time their gout flares become more frequent or last longer. This is called chronic gout.

Gout Testing and Diagnosis Process

Gout can be tricky to diagnose because many illnesses can cause joint pain and inflammation. Your doctor may suspect gout if you’ve had a sudden attack of joint pain followed by a period with no symptoms. A high blood level of uric acid can be suggestive of gout, but the best way to diagnose the disease is sampling fluid from an inflamed joint and looking for gout crystals.

Should You Get Tested for Gout?

Your primary care physician is the first person to see if you’ve been experiencing gout symptoms.

Primary care physicians can often diagnose and treat gout. They can also refer you to a gout specialist, known as a rheumatologist, for further testing or treatment.

Tests for gout include:

Synovial Fluid Analysis

Sometimes called a joint fluid analysis, this is considered the best way to diagnose gout. Synovial fluid is a thick, light-colored substance that lines the insides of your joints.

You may receive a shot to numb the area. The procedure typically lasts only one to two minutes. Your doctor will insert a needle into the joint space to draw up some of the fluid, then send a sample of the fluid to a laboratory.

A laboratory technician will look at the sample under a microscope to check the fluid for signs of gout or other conditions that can cause joint swelling, including infection and pseudogout. Signs of gout include urate crystals in the fluid. (5)

Uric Acid Test

Your doctor may recommend a uric acid blood test to help diagnose gout.

Uric acid is a chemical that’s normally found in the blood as a waste product from the breakdown of certain foods. People with gout have too much uric acid in their body.

This test simply measures how much uric acid you have in your blood.

People with gout sometimes have high uric acid levels. In people with symptoms of gout, a high uric acid blood test reading (above 6.8 milligrams per deciliter) may indicate gout.

A uric acid blood test isn’t definitive proof of gout. Many people with high uric acid levels don’t have gout, and some people with gout don’t have high uric acid levels. Between 12 and 43 percent of patients experiencing a gout flare may actually have low to normal blood levels of uric acid. (6)

Ultrasound

This imaging technique uses sound waves to make a picture of what’s going on inside an inflamed joint. Ultrasound can help your doctor identify crystals in the fluid between your joints.

In an ultrasound exam, your practitioner will apply a thin layer of gel to the skin over the joint, and then place the ultrasound probe directly on the skin. (7)

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