Gout can present in a number of ways, although the most usual is a recurrent attack of acute inflammatory arthritis (a red, tender, hot, swollen joint). The metatarsal-phalangeal joint at the base of the big toe is affected most often, accounting for half of cases.Other joints such as the heels, knees, wrists and fingers may also be affected. Joint pain usually begins over 2–4 hours and during the night. The reason for onset at night is due to the lower body temperature during this time.
Other symptoms that may occur along with the joint pain include fatigue and a high fever.
Long-standing elevated uric acid levels (hyperuricemia) may result in other symptomatology including hard, non-painful deposits of uric acid crystal known as tophi. Extensive tophi may lead to chronic arthritis due to bone erosion. Elevated levels of uric acid may also lead to crystals precipitating in the kidneys resulting in stone formation. This may result in urate nephropathy ( is a rapidly worsening (decreasing) kidney function (renal insufficiency) that is caused by high levels of uric acid in the urine) .
Hyperuricemia is the underlying cause of gout. This can occur for a number of reasons including dietary, genetic, or underexcretion of urate, the salts of uric acid. Renal underexcreation of uric acid is the primary cause of hyperuricaemia in about 90% of cases while overproduction is the cause in less than 10%. About 10% of people with hyperuricemia develop gout at some point in their lifetime. The risk however varies depending on the degree of hyperuricemia.
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