6 Symptoms Never to Ignore With Gout

Medically Reviewed By William C. Lloyd III, MD, FACS
— Written By Nancy LeBrun
Updated on July 29, 2021

Gout stands as the most prevalent form of inflammatory arthritis, affecting approximately 8 million Americans. This chronic condition manifests through acute attacks, triggered by an accumulation of uric acid within the body. When uric acid levels become excessively high, it leads to the formation of sharp, needle-like crystals that deposit in the joints. These crystal deposits incite severe pain, accompanied by pronounced redness, swelling, and tenderness in the affected areas. While gout attacks are characterized by intense symptoms, certain signs can signal the development of more serious complications, necessitating prompt medical evaluation to prevent long-term health issues and preserve joint function.

1. Hard Bumps Under Your Skin

The appearance of hard bumps beneath the skin, known as tophi, is a significant indicator of advanced gout. Tophi are essentially visible clusters of uric acid crystals that have solidified and accumulated over time. While they commonly form on fingers, hands, feet, ankles, or other joints, they are also frequently observed on the ears. Initially, tophi may not cause pain, but their presence is a clear signal of prolonged elevated uric acid levels. Ignoring these formations can lead to irreversible joint damage and erosion of surrounding tissues, as the crystal deposits continue to expand and compromise structural integrity.

Beyond joint destruction, large tophi can pose additional risks. They may become so substantial that they eventually rupture through the skin, creating open wounds that are highly susceptible to infection. Such infections require immediate medical attention, often treated with antibiotics. In some instances, particularly when tophi cause significant pain, impede joint movement, or are at high risk of bursting or infection, surgical removal may be a necessary intervention. Prompt recognition and treatment of tophi are crucial for managing gout and mitigating its potential to cause severe, lasting complications.

2. Pain in Side, Lower Abdomen, or Groin

As individuals age, the kidneys’ efficiency in processing and eliminating uric acid from the body naturally declines. This age-related reduction in kidney function, combined with elevated uric acid levels characteristic of gout, significantly increases the risk of developing kidney stones and, in more severe cases, chronic kidney disease. Kidney stones formed from uric acid crystals can cause excruciating, sharp pain that may originate below the ribs in the side or back, radiating into the lower abdomen and groin area. This pain often presents in intermittent waves, making it distinctive and highly distressing.

The insidious nature of kidney disease means that symptoms often do not manifest until the kidneys are considerably impaired. Therefore, for individuals with gout, experiencing pain in these specific areas—even when not in the midst of a gout attack—warrants immediate medical consultation. Early detection of kidney stones or emerging kidney dysfunction is vital. Addressing these complications promptly can prevent further damage to renal function, manage pain effectively, and implement strategies to control uric acid levels, thereby protecting the kidneys from long-term, irreversible harm.

3. Pain When Urinating

Gout uniquely contributes to the formation of a specific type of kidney stone: those comprised of uric acid crystals. These small, hardened masses develop within the kidneys, and if one detaches and attempts to pass through the urinary system, it can become lodged in the ureter—the tube connecting the kidney to the bladder. Such an obstruction can severely impede or entirely prevent urination, resulting in intense and debilitating pain. The experience can be agonizing and often indicates a medical emergency requiring swift intervention.

Beyond the direct pain of obstruction, uric acid kidney stones can also lead to other concerning urinary symptoms. It is critical to be vigilant for any visible changes in urine, such as a red or brown tint, which signals the presence of blood. Additionally, a foul odor or cloudy appearance of the urine can indicate an infection or other complications associated with the stone. These symptoms collectively suggest the presence of a gout-related kidney stone that requires prompt diagnosis and treatment. Ignoring these signs can lead to worsening pain, infection, and potential kidney damage.

4. High Fever

While a mild fever and a general feeling of malaise can sometimes accompany a gout attack, a significantly elevated fever, particularly above 100°F (38°C), demands immediate medical attention. In severe cases of gout, a high fever often signals a more serious underlying issue, such as an acute infection within the affected joint or extensive joint erosion. When a gout-inflamed joint also feels intensely hot and swollen, the combination of these symptoms strongly suggests a bacterial infection has developed.

Joint infections are serious complications that can rapidly spread beyond the affected joint to other parts of the body, potentially leading to systemic illness or even sepsis, a life-threatening condition. Therefore, if you experience a high fever alongside a gout attack, especially with marked localized heat and inflammation, it is crucial to contact your doctor without delay. Prompt medical assessment and treatment, often involving antibiotics, are essential to contain the infection, alleviate symptoms, and prevent its dangerous spread, safeguarding your overall health and preventing further joint damage.

5. Daytime Sleepiness

Persistent daytime sleepiness, along with difficulty concentrating, can be an unrecognized but significant symptom linked to gout, often pointing towards underlying sleep apnea. Sleep apnea is a condition where individuals experience brief, repeated interruptions in breathing throughout their sleep cycle. These pauses in respiration lead to intermittent drops in blood oxygen levels. The body’s response to this reduced oxygen supply can, in turn, elevate uric acid levels, thereby increasing a person’s susceptibility to gout attacks or exacerbating existing gout.

The profound fatigue and impaired concentration experienced by those with untreated sleep apnea can significantly diminish quality of life and productivity. More critically, sleep apnea is strongly associated with several severe health conditions, including high blood pressure, cardiovascular problems, and an increased risk of stroke. Therefore, if you consistently feel tired and struggle to focus during the day, consulting your doctor is paramount. Diagnosing and treating sleep apnea can not only help manage gout by addressing a root cause of elevated uric acid but also mitigate the risk of other serious health complications.

6. Back or Neck Pain

While back and neck pain are common ailments with numerous potential causes, their occurrence in individuals with a history of gout should prompt a thorough evaluation for a rare but serious complication: spinal gout. Spinal gout develops when uric acid crystals deposit within the spinal column, leading to inflammation and damage to vertebrae, and potentially impinging upon nerves. This can manifest as unexplained back or neck pain, or more concerning neurological symptoms such as tingling or numbness radiating into an arm or leg, indicating nerve compression.

If left untreated, spinal gout can lead to severe consequences, including significant nerve damage and, in extreme cases, paralysis. While other conditions more commonly cause back pain, it is vital for individuals with a history of gout attacks in other joints to discuss any new or persistent back or neck discomfort with their physician. Early diagnosis allows for targeted treatment aimed at reducing uric acid levels, which can alleviate symptoms and prevent further damage. In situations where tophi are compressing the spinal cord or nerve roots, causing pain, numbness, or weakness, surgical procedures may be necessary to remove the deposits and decompress the affected neural structures.

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About The Author

Nancy LeBrun
Nancy LeBrun is an Emmy- and Peabody award-winning writer and producer who has been writing about health and wellness for more than five years. She is a member of the Association of Health Care Journalists and the American Society of Journalists and Authors.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jul 19

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

Medically Reviewed By William C. Lloyd III, MD, FACS
— Written By Nancy LeBrun
Updated on July 29, 2021

Original article: https://resources.healthgrades.com/right-care/gout/6-symptoms-never-to-ignore-with-gout