Uric Acid Crystals can take a long time (months or years) to accumulate, most commonly in connective tissues in and around joints, especially in the lower limbs. During this period there may well be no symptoms whatsoever. About 95% of people with hyperuricemia, high uric acid in the blood supply, will not have a gout attack throughout their entire lives. However, they may experience pain and discomfort from crystallized uric acid in their joints. Pain in the heel/Achilles tendon is very common. Sometimes uric acid problems are even misdiagnosed as Rheumatoid Arthritis. The uric acid crystals will cut into the synovial fluid sacks that cushion all joints releasing this fluid into the blood. This can cause blood readings to indicate Rheumatoid Arthritis when, in fact, the problem is really uric acid crystals.
A single joint is almost always involved in the initial episodes of an acute attack, most commonly starting with the big toe. This involves local irritation and aching with the tissues becoming swollen, red, hot, shiny and excessively painful. The pain is frequently described as the worst ever experienced.
There are periods between attacks. Some never experience another attack, or perhaps at least not for several years. However, for the majority, a second attack occurs within a year. The frequency, severity, and number of joints involved are highly likely to increase over time. This progression eventually leads to joint damage and chronic pain over an average of about 10 years.
Chronic tophaceous gout large crystal deposits, or tophi, produce irregular firm nodules, predominantly around the upper surfaces of the fingers and hands. They can form in other places as well, including forearms, Achilles tendon, and/or the ears. When left untreated, these can lead to severe deformity.