The 4 Stages of Gout

Medically Reviewed By William C. Lloyd III, MD, FACS
x ray of feet showing gout

Gout is a type of arthritis best known for its painful attacks on the big toe. In fact, this inflammation of the big toe—also known as podagra—occurs at some point in as many as 80% of people with gout.

But the disease actually progresses through four stages, from the silent buildup of uric acid in the blood to chronic arthritis. Here’s what’s happening at each stage, and how to keep your gout from progressing to the next level.

Stage 1: Asymptomatic Gout

Gout occurs when a substance called uric acid builds up in the blood. Uric acid forms naturally when our bodies break down purines, compounds found in our own tissues and in certain foods. Not everyone with elevated uric acid develops gout—more is involved.

Normally, uric acid is dissolved in the blood, filtered by the kidneys, and passed out through urine. In people with gout, however, this process goes awry. This can happen when you eat too many purine-rich foods, including liver, dried beans, mushrooms, and peas. In other cases, your kidneys don’t remove enough uric acid from the body.

In gout’s earliest stages, uric acid accumulates in the blood, causing a condition known as hyperuricemia. There are usually no symptoms, and no treatment is required—but the uric acid could still be harming your body.

Stage 2: Acute Gout

Eventually, excess uric acid forms crystals that collect in the spaces within joints. These needle-like crystals (monosodium urate, or MSU) are what cause pain in the big toe. They can also affect other joints, including the ankles, feet, knees, and wrist.

Acute flare-ups can strike suddenly, often at night, and last from days to weeks. Besides pain, other symptoms include redness, swelling, and warmth at the affected joint.

Gout attacks can be triggered by stress, other illnesses, drugs and alcohol, or too much meat or seafood. When you’re experiencing a flare-up, get treatment quickly to prevent permanent joint damage. Rest, avoid alcohol, cut back on animal proteins, and use an ice pack to cool and soothe the joint.

Stage 3: Interval or Intercritical Gout

Like the calm in the eye of a storm, gout can lie dormant between attacks. You’ll usually experience a pain-free period after an attack that can last months or even years.

However, uric acid may continue to build up in your bloodstream and joint spaces, plotting its next assault. Continue to see your doctor regularly and follow his or her orders for eating right, drinking plenty of water, and taking medicine. Losing weight if you’re heavy can also prevent future attacks.

Stage 4: Chronic Tophaceous Gout

This is the most debilitating form of gout. It usually takes a long time to develop—up to 10 years—and is most common in those whose gout is not treated.

If your gout is chronic, you may continuously experience symptoms typical of other types of arthritis, including aching, sore joints. In addition, you may develop nodules of uric acid in the soft tissue around your joints. These are known as tophi and are most common on the fingers, elbows, and toes.

Uric acid can also eventually damage your bones and build up in your kidneys, causing kidney stones and other damage.

Stop Gout Before It Strikes Again

Changing your lifestyle can help you prevent new gout attacks and slow the disease’s advancement. Your doctor may recommend:

  • Eating one less portion of meat or seafood per day

  • Drinking wine instead of beer, or avoiding alcohol completely

  • Drinking one glass of skim milk per day, since low-fat dairy appears to lower uric acid levels and have a protective effect

Anti-inflammatories and corticosteroids can treat the symptoms of gout attacks. Your doctor may also prescribe newer medications that reduce the amount of uric acid in your blood.

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  1. Gout. American Academy of Family Physicians.

  2. Gout. National Institute of Health Senior Health.

  3. Gout. Centers for Disease Control and Prevention (;
  4. FDA Approves New Drug for Gout 2010. U.S. Food and Drug Administration.
  5. What is Gout? Fast Facts. National Institute of Arthritis and Musculoskeletal and Skin Diseases.
  6. Gout. American College of Rheumatology.

Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Sep 22
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