4 Stages of Gout

According to western medical science gout has 4 stages. This is viewing gout from a prolonged condition, rather than the stages of an individual attack.


These 4 stages are said to be:

  1. Asymptomatic Hyperuricemia
  2. Acute Gout
  3. Interval Gout
  4. Chronic Tophaceous Gout

These are outlined in more detail at the bottom of the page.

The Typical Gout Journey 

The very first acute attack is like the opening shot of a long building feud. Your body has been pushed into an acidic state and as a result hits you with a huge amount of pain. You get yourself to the doctor or the hospital, get x-rays and bloodwork done and then wait around for an answer.

The medication they give you does little to ease the pain and you learn about the evils of uric acid, purines and your ancestors.

But the acute attack does pass.


Following on from the acute attack will come another painless period where your body is becoming gout friendly again. You will suffer more frequent attacks and these will often last longer and be more painful. This is the experience that I had and others I have spoken with have had.

It’s essentially a problem through a lack of understanding that your daily routine, your behavior is the cause of your suffering. Gout is a condition that has to have a certain environment created for it to exist.

It needs to have that drop in alkalinity over a prolonged period of time. This is why it was always known as the king’s disease or a rich man’s disease, because these people were the ones able to afford to make that environment in their body the most often and most easily.

Final Stages of Gout

One thing is for sure, if you leave gout untreated it really is a dangerous condition.

Gout messes up your joints, plain and simple, but the more times you mess up the same joint, the more likely it is going to cause you permenant and irreversible damage.

Gout really is a call for help from your body and a signal that you need to change your lifestyle and behavior. It signals that in your future other conditions are likely to lurk, such as obesity, heart disease, diabetes, stroke and so on.

Tophi is the end game for gout, it is like a visual shaming of your behavioral habits. Deposits of uric acid crystals start forming around your joints. Ankles, toes, knees, fingers, elbows and in my dad’s case horn like lumps on his ears!

Gout can and does move from one stage to the other so you need to take charge of your diet, your lifestyle and your future.

Stage 1

Asymptomatic Hyperuricemia is the period where the body or more accurately the blood is overloaded with uric acid. It is important to understand that your body naturally creates uric acid. In the hyperuricemic state, there is simply too much uric acid and this enables the environment to become gout friendly.

The increase in uric acid could be due to excess production because of the things that you have eaten, drunk and otherwise experienced in recent days.

The other possible reason is that your kidney function is reduced and as a result the uric acid is not filtered out quick enough and therefore it is able to build up.

What your cause of this excess uric acid is needs to be identified and eliminated and that can only come about through action from yourself.

Stage 2

The next stage is acute gout.

Acute gout is essentially the flare up, the attack THE PAIN. This is the stage that attacks many people seemingly without warning in the middle of the night.

It is a trial, an ordeal, a life changing event that has people running the whole gamut of emotions as they try to figure out what the hell is happening to them. There’s no injury to the area and no reference point for where the pain is coming from.

This sudden world of pain that people are introduced to demands that you wake up to yourself and stop what you are doing.

I remember on my first gout attack I had no idea what it was and no idea what caused it. I remember actually sitting in a bar, with my friend drinking beer thinking that if I drank enough the pain would go away!

Talk about not having a clue!

Acute gout attacks last from a few days to possibly even a few weeks.

However, once an attack subsides, the gout sufferer most often seems to think that it is over and it’s not coming back. As if it was something like a cold that they’ve managed to fight off.

But that isn’t how gout works and WHAM! It comes back. Then the flare up usually lasts a little longer, but goes away in time and the individual goes back to the life they were living.

Stage 3

`Interval gout’

Interval gout is described as the `asymptomatic period between acute attacks of gout’

What does that mean? Well not a lot really, it means the painless time where someone that has not received the right education on gout allows their body to become gout friendly once more.

The intervals between gout attacks vary from the very short (a few days) to even a few years.

Stage 4

Chronic Tophaceous Gout

This stage I prefer to think of as two stages,


Chronic just means long term. This is where you get repeated acute gout attacks over time. These attacks are often not only more painful but last longer.


chronic-gout Symptoms-of-Gout figure102







Tophus (tophi is plural) are basically deposits in/around your joints of uric acid crystals. They are the direct result of a body that is too acidic over long periods of time.

The danger with tophi is that they are slow to form and also relatively painless.

But the fact that they are not causing a massive amount of pain as they build up is not a reflection of the seriousness of tophi. They really are some scary looking things as the pictures prove, but the main thing with them is that this build up can also be happening in your kidneys and this is what creates a kidney stone.

Therefore if you do spot a tophi growing it should be viewed for what it is:

Your body’s last attempt to show you that you need to re-educate yourself and change your ways.

Your body sends out the acute attacks to grab your attention that you need to change. But most of us whether we want to admit it or not are quite stubborn creatures.

Behavioural change is the key in your gout freedom and this comes with education.