Gout Stages, Pictures, and Treatments

Gout is a common type of arthritis that causes sudden pain and swelling in one or more joints. It develops in some people who have high levels of uric acid in their blood. Uric acid, a natural waste product, forms crystals that can deposit in joints and the skin. This causes pain and inflammation. 

Knowing the signs and symptoms of gout is the first step in getting the right diagnosis. Luckily, gout has some pretty unique features at every stage that can make it easy to spot. 

What are the different stages of gout?

It can take many years to progress from your first attack of gout (stage 1) to chronic gout (stage 4). Getting diagnosed and treated early can prevent the progression to chronic gout. It’s possible to never develop chronic gout and to never deal with another gout flare again. 

Here are the four stages of gout. 

Stage 1: Asymptomatic hyperuricemia 

People in this early stage have high levels of uric acid in their blood (hyperuricemia) but haven’t yet developed symptoms. There’s no way of knowing you have a high uric acid level unless it’s picked up on a blood test. Not everyone with high uric acid levels will develop gout.

Stage 2: Gout flares

At first, gout flares usually involve one joint at a time. Typically, gout starts in a big toe or a knee. But gout can affect any joint. 

After a while, flares can involve multiple joints at once (like all the joints in your foot). 

Gout flares usually get better within 1 to 2 weeks. 

Stage 3: Intercritical gout

This is the stage in between gout flares. For some people, this stage may last years. In other words, it may be years before they have another gout flare after their first gout episode. For others, gout flares may happen every few months or even weeks. 

Without gout treatment, gout flares happen more often. 

Stage 4: Chronic tophaceous gout 

If you continue having recurrent gout flares, gout can progress to this chronic stage. With chronic gout, you can have joint pain and swelling that doesn’t improve between episodes. 

People with chronic gout also develop “tophi.” These are collections of uric acid crystals in the joints and underneath the skin. They look like chalky, white bumps. Chronic tophaceous gout can cause permanent joint damage and deformities. The good news? It’s preventable with gout treatment. 

EXPERT PICKS: WHAT TO READ NEXT

• Taking allopurinol? From blood pressure medications to antibiotics, learn five common medications that can interact with allopurinol. 

• Gout and your diet: A nutritious and balanced diet may be more important than completely eliminating a particular food. But avoiding foods high in purine can help to prevent flares.

• Dealing with a painful, swollen joint? There are many different types of arthritis, and knowing which one you have is the first step to getting the right treatment.

What does gout look like?

A gout attack causes sudden swelling, redness, and pain in and around the joint. Gout often involves the big toe (called podagra), but other joints can be affected too. 

In chronic gout, tophi can develop, especially near the knees, elbows, fingers, and ears. Tophi can be chalky white, yellow, or skin-colored. Some are smaller than a pencil eraser, while others can be several inches wide. Sometimes, they can break through the skin, releasing tiny amounts of chalky, white material.

Here are some pictures of chronic gout with tophi and swollen joints in different parts of the body. 

Close-up of the hand showing gout on the thumb and finger.

Close-up of a thumb with yellow-white tophi caused by gout.

Close-up of a tophus on the ear.

Close-up of an elbow with a gout tophus.

How is gout diagnosed?

The best way to diagnose gout is with a joint aspiration. In this office procedure, your healthcare professional (usually a rheumatologist) will use a needle and syringe to withdraw a small amount of fluid from your joint. They will then look at the fluid under a microscope to see if there are uric acid crystals. 

In some cases, your healthcare professional can diagnose gout without a joint aspiration. They may be able to do this based on your symptoms, physical exam, and blood test results. An X-ray can also help rule out other causes of joint pain.

How do you treat gout?

Treating gout is a two-pronged approach. The first step is to treat the active gout attack. The second step is to prevent future gout flares. 

• Treatment for an active gout flare: Gout attacks are treated with medications like colchicine, prednisone, and nonsteroidal anti-inflammatory drugs (NSAIDS). A steroid injection into an affected joint might also be an option.

• Preventing future gout flares: Longer-term prevention focuses on lowering uric acid blood levels below 6.0 mg/dL so that gout attacks can’t happen. For this, you have to take medications like allopurinol and febuxostat every day. 

When you start gout prevention treatment:

• Start with a low dose of allopurinol or febuxostat.

• Gradually increase the dose until uric acid level drops below 6 mg/dL.

• Continue taking medication to treat gout (like colchicine, prednisone, or NSAIDs) during this time. 

• Once uric acid level is under 6 mg/dL and you’ve had no gout flares for one month, you can stop the active gout treatment and continue the preventative gout treatment.

Lifestyle changes, like changing your diet and maintaining a weight that feels best, are helpful for your overall health. But without gout medications, this is usually not enough to prevent gout episodes.

When to see a healthcare professional about gout 

You should always get emergency medical attention if you suddenly develop a painful, swollen joint that you can barely move, and a fever. It could be a joint infection, which may have serious consequences. For less severe symptoms, call your doctor’s office as soon as possible to determine the next best steps. 

Frequently asked questions

Why trust our experts?

Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

Our editorial standards

Meet our experts

Images used with permission from VisualDx (www.visualdx.com).