What are the common symptoms of gout in women?

Gout is more common in middle-aged men, while women account for only 5%, mainly postmenopausal women. Gout attacks tend to be younger. The natural course of gout can be divided into four stages, namely, the asymptomatic hyperuricemia stage, the acute stage, the intermittent stage, and the chronic stage. So what are the symptoms of gout in women?

1. Acute gouty arthritis

Most patients have no obvious signs before an attack, or only experience fatigue, general malaise, and joint pain. A typical attack often starts in the middle of the night with joint pain, which progressively worsens and reaches its peak in about 12 hours, with tearing, cutting, or biting sensations that are unbearable. The fatigued joints and surrounding tissues become red, swollen, hot, painful, and have limited function. Usually relieves on its own within a few days or 2 weeks. The first attack often affects a single joint, and some attacks occur in the first metatarsophalangeal joint. In the subsequent course of the disease, some patients have involvement of this part. The next most common joints are the dorsum of the foot, heel, ankle, knee, wrist and elbow. The shoulder, hip, spine and temporomandibular joints are less frequently fatigued. Multiple joints may be affected at the same time, manifesting as polyarthritis. Some patients may have systemic manifestations such as fever, chills, headache, palpitations and nausea, which may be accompanied by increased white blood cell count, increased erythrocyte sedimentation rate and increased C-reactive protein.

2. Intermittent attack period

Gout attacks can last for several days to weeks and then subside on their own, usually with no obvious sequelae, or leaving some skin pigmentation, desquamation and itching, then enter an intermittent period without symptoms, lasting for several months, years or more than ten years before recurring. Most patients relapse within one year, and the symptoms become more and more frequent, with an increasing number of fatigued joints and symptoms lasting longer and longer. The fatigued joints usually spread from the lower limbs to the upper limbs, and from the distal small joints to the large joints, showing fatigue in the fingers, wrists, elbows and other joints. A small number of patients may be affected by the shoulders, hips, sacroiliacs, sternoclavicular or spinal joints, and may also involve the bursae, tendons and tendon sheaths around the joints, and the manifestations tend to be atypical. A small number of patients have no intermittent period and present with slow arthritis symptoms after the initial onset.

3. Slow tophi stage

Subcutaneous tophi and chronic tophi arthritis are the result of long-term and significant hyperuricemia, with large amounts of monosodium urate crystals accumulating in the subcutaneous tissue, synovium, cartilage, bone, and soft tissues around the joints. The typical site for subcutaneous tophi attacks is the auricle, and it is also common around joints with recurrent attacks and in areas such as the olecranon, Achilles tendon, and patellar bursa. The appearance is yellow-white growths of varying sizes raised under the skin. The skin surface is thin and soft, and white powdery or pasty substances are discharged after rupture, which does not heal for a long time. Subcutaneous tophi often coexist with chronic tophi arthritis. Large amounts of tophi accumulated in joints can cause joint bone damage, peri-articular tissue fibrosis, and secondary degenerative changes. The clinical manifestations are persistent joint pain, tenderness, deformity and dysfunction. The symptoms during the slow phase are relatively mild, but there may also be acute attacks.

4. Kidney disease

(1) Chronic urate nephropathy Urate crystals accumulate in the renal interstitium, causing chronic tubulointerstitial nephritis. The clinical manifestations include decreased urine concentrating function, increased nocturia, low specific gravity urine, small molecule proteinuria, leukocyturia, mild hematuria and tubular urine. In the late stage, it can lead to decreased glomerular filtration function and renal insufficiency.

(2) Uric acid urinary stones: The uric acid concentration in the urine increases to an oversaturated state, accumulates in the urinary system and forms stones. The incidence rate among gout patients is over 20%, and may occur before the onset of gouty arthritis. Small stones are excreted in the urine in the form of gravel and may not cause any symptoms; larger stones may block the urinary tract, causing kidney pain, hematuria, difficulty urinating, urinary tract infection, renal pelvic dilatation and hydrops, etc.

(3) Acute uric acid nephropathy: The uric acid levels in the blood and urine increase sharply, and a large number of uric acid crystals accumulate in the renal tubules, collecting ducts, etc., causing acute urinary tract obstruction. The clinical manifestations are oliguria, anuria, and acute renal failure; many uric acid crystals can be seen in the urine. It is mostly caused by secondary causes such as malignant tumors and their chemotherapy and radiotherapy (i.e. tumor lysis syndrome).