“You would have a really swollen hot, painful joint, and that would usually come around at night,” says Dr. Joel  R. Pittman, pharmacist and assistant professor of pharmacy practice at the University of Mississippi School of Pharmacy. “It would be so painful you wouldn’t even want to touch it. Some people can’t even stand to have the pressure of the bed sheet on it!”

"When someone comes in with a big, red hurting joint, and usually with gout it is the joint next to big toe right where it attaches to the foot, and it hurts to walk or even when the sheet hits it, I know I’m probably looking at gout” says Dr. Jeffrey J. Cain, president-elect of the American Academy of Family Physicians“If your skin is red and feels warmer than the skin around it and you haven’t injured it, it could be gout or another infection, and you should go see your doctor.”   

“Over 24 hours, if you have a painful, warm, red swollen joint you don’t even want to touch, reach out to your physician and make sure you get seen,” says Dr. Patience White, vice president for public health at the Arthritis Foundation. “Most people focus on drug treatment, weight loss and eating less purine-rich food to help control it.”

Breaking down

Purines are natural organic compounds found in all human cells and many foods. They are part of the process of breaking down uric acid, which is cleared through the kidneys. “A lot of this is related to genetics and co-morbidities,” says Dr. White. “We don’t know the actual gene or genes it is linked to, but we do know if someone in your family has gout, you are more likely to have it than someone who has no family history of it. The other health conditions associated with gout also have genetic components, such as diabetes, high cholesterol and heart disease.” 

Symptoms may include:

  • Warmth, pain and swelling in one joint, usually the big toe 
  • Intense pain that typically begins at night, and is so painful you don't even want to put your sheet on it
  • Increasing discomfort and pain that lasts for days
  • Discoloration

"You’ll feel something is wrong. It [a joint] will get highly swollen. You couldn’t possibly miss it. It gets so red you can see it from across the room, so hot it feels like you could fry an egg on it, and so painful you can’t even let a sheet touch it. It would last like that for about a week if you did nothing. It might not come back for months or even years. It is the most sudden, horrible, pain. Women have been known to say it’s worse than child birth or kidney stones,” explains Dr. Alan Friedman, board of directors, American College of Rheumatology, Research and Education Foundation.

“When the crystals come into the joint, the body recognizes they don’t belong there,” he continues.  “The white blood cells try to eat the crystals, and then they tend to make a lot of chemicals that cause heat. It’s the white blood cells chewing on the crystals that create heat.”

So if gout hurts that bad, and the symptoms are so recognizable, why is it often mismanaged?

“Gout is very prevalent in middle-aged men, and this is a group notorious for not being attentive to their chronic medical care and not using doctor services,” explains Dr. William P, Jennings, medical director at Radiant Research, San Antonio. 

The drugs that prevent gout actually trigger attacks if not taken in the prescribed matter, so it is imperative that men and women alike take their medicine correctly; non-compliance is a big issue.  “Men will not take their medicine if they are not acutely sick,” says Jennings. “They stop the preventative medicine and then they wait until they feel pain to take a pill. If they are not attentive to their chronic care, if they are intermittent in their care or only treat for acute gout, they’ll have a real problem.”