For years before the first Gout attack occurs, at-risk individuals doing routine medical screening may have noticed elevated blood uric acid levels, defined as above saturation point (7 mg/dL or 400 µmol/L) at core body temperature. This is the asymptomatic stage.
The acute Gout attack commonly starts suddenly as a sharp throbbing pain in the ankle or big toe, typically peaking as an excruciatingly tender red hot swelling within 6-8 hours, but usually resolves in 5-7 days.
As the crystal burden worsens, attacks become more frequent, and last longer, to the point of constant inflammation and pain. More joints can become affected, and sizable deposits of urate crystals may be visible as lumps (tophi) at the toes, heels, fingers and elbows. Gout has reached the chronic stage, mimicking other chronic inflammatory arthritis like Rheumatoid Arthritis. Without proper treatment, permanent joint damage and disability will accrue.