Gout is a disease due to an overabundance of uric acid (UA) in the body. Under normal circumstances, purines, which are natural constituents of many foods, are converted into UA, and then excreted.
With gout, UA is either produced in overabundance or the body has difficulty getting rid of it fast enough.
There are three stages of gout. The first is called asymptomatic hyperuricemia. What that means is that the body has too much UA on board. The UA level in the blood is high. But the patient has no symptoms. During this period, UA builds up in body tissues. The patient may or may not ever get gout symptoms. People who have this condition may have other medical problems such as elevated cholesterol, obesity, diabetes, and high blood pressure.
If this condition lasts long enough, the patient will enter the phase of acute gout. This is when severe, painful attacks of gouty arthritis can develop. The attacks usually present in the ankles and feet. The pain is so severe the patient won't even be able to bear the weight of a bed sheet on top of the affected area. Once this acute attack goes away, the patient will remain symptom free until the next attack. The second attack and subsequent attacks may not occur for many months or even years.
The last stage of gout is advanced gout where acute flares occur with regularity. The time periods between acute attacks are no longer pain free. Accumulations of UA build up near the joints and under the skin. These are called tophi.