Are there different stages of gout?

William J. Martin, MD
Gout has three stages of development. The first stage is asymptomatic hyperuricemia, wherein a person has a high level of uric acid in the blood but no symptoms of gout. This can go on for years, and some people can live their whole lives with a high uric acid level and never get gout. Others have high uric acid for years but eventually have a gout attack. The first stage ends with the first major attack of acute gout. Stage two is called intercritical gout, during which there are periodic flares of gout. People at this stage are usually untreated, as doctors typically don’t treat for gout until there are around two attacks per year. When someone begins to have two or more flares per year, doctors begin to treat to lower the frequency of these flares. In the final stage, chronic gouty arthritis, people develop chronic deposits of uric acid crystals (tophi).
There are four stages of gout based on the intensity of your symptoms. The first stage is called asymptomatic hyperuricemia. During this stage, uric acid levels begin to increase, but there are no other symptoms. Physical symptoms including an initial attack occur in the second stage, acute gouty arthritis. The third stage describes the period between attacks, intercritical gout. The fourth stage is the most severe. In the chronic tophaceous gout stage, attacks are frequent and deposits of tophi (uric crystals) begin to collect under the skin.

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