Gout doesn’t always start with a swollen big toe. Other gout symptoms can include:

• Low-grade fever
• Fatigue
• Pain in the wrists, fingers, or knees
• Hard lumps under the skin
• Peeling skin after a flare 
• Joint stiffness that comes and goes

When caused by gout, ignoring these signs can allow uric acid crystals to keep damaging your joints.

What is Gout, and Why Can it Be Easy to Miss?

Gout is a form of inflammatory arthritis caused by too much uric acid in the blood. When uric acid levels stay high, sharp needle-like crystals can form in and around joints, triggering painful inflammation.

While many people with gout experience sudden, severe pain in the big toe, often overnight, gout is more varied than that. Some people have milder or atypical symptoms, and they often blame them on aging, overuse, or a minor injury. It’s important to be aware of these less common symptoms because a delayed diagnosis can allow untreated gout to progress.

What Are the Uncommon Symptoms of Gout?

The following are several symptoms that could indicate gout:

Pain in Joints Other Than the Big Toe

Early attacks often favor the feet, but gout can affect the ankles, mid-foot, knees, wrists, fingers, and elbows. Repeated flares can spread to other joints. A hot, swollen finger or wrist is easily mistaken for a sprain or another type of arthritis.

Low-Grade Fever and Chills

Gout is an inflammatory condition, so a flare can make you feel unwell all over. Some people notice a mild fever, chills, or a general sense of being sick during an attack. Because these symptoms also suggest infection, joint pain with fever should always be evaluated promptly.

Fatigue and Malaise

Widespread inflammation can leave you tired and run down. If unexplained exhaustion shows up alongside joint discomfort, it’s worth mentioning to a doctor.

Redness That Looks Like an Infection

A gout flare can make the skin over a joint look red, shiny, and warm. This redness can resemble a bacterial skin infection known as cellulitis, which is one reason gout is sometimes misdiagnosed.

Peeling or Itchy Skin After a Flare

As swelling goes down, the skin over the affected joint may itch, flake, or peel. Many people don’t recognize that this symptom means a flare has just taken place.  

Lingering Stiffness and Mild, Nagging Pain

Not every attack is dramatic. Some people experience smoldering, low-level joint pain and stiffness that never fully resolves, which can signal ongoing crystal deposits.

Firm Lumps Under the Skin (Tophi)

Tophi are chalky deposits of uric acid crystals that can form near joints, on the fingers, elbows, or Achilles tendon, or on the ears. They are usually painless at first, which makes them easy to dismiss. Tophi generally point to long-standing, poorly controlled gout and can lead to joint damage.

Tendon and Bursa Problems

Gout can inflame tendons and the fluid-filled sacs (bursae) around joints. Sudden swelling at the back of the elbow or heel pain that doesn’t improve with rest may sometimes have gout behind it.

Kidney Stones

High uric acid can also form stones in the kidneys. Severe back pain, blood in the urine, or repeated stones can sometimes be linked to the same underlying problem.

Who Is Most At Risk for Gout?

Gout is more common in men, in women after menopause, and in people with a family history. Other risk factors include:

• Obesity
• High blood pressure
• Diabetes
• Chronic kidney disease
• Certain medications such as diuretics
• Diets high in red meat, shellfish, alcohol, and sugary drinks

How is Gout Diagnosed?

Since gout is an inflammatory arthritis that often affects joints, a rheumatologist is the best positioned to diagnose gout. A rheumatologist will usually combine your health history, a physical exam, and testing, which can include: 

• Checking blood uric acid levels
• Analyzing fluid drawn from the joint to look for crystals, or 
• Using imaging such as ultrasound or dual-energy CT to detect deposits 

Testing is important because gout can mimic infection, pseudogout, and other forms of arthritis.

When Should You See a Rheumatologist?

Make an appointment with a rheumatologist if you have repeated joint pain or swelling, unexplained lumps near joints, or symptoms that keep returning. Seek urgent care right away if you have a hot, swollen joint with fever, since infection needs to be ruled out quickly. 

Left untreated, gout can cause repeated flares, permanent joint damage, tophi, and kidney problems. The good news is that it is highly treatable. Care usually includes medication to calm flares, long-term therapy to lower uric acid, and lifestyle changes. Limiting alcohol, staying hydrated, and managing weight and other health conditions can dramatically improve your quality of life with gout.

At Advanced Rheumatology of Houston, we find that many clients assume mild joint pain and swelling is a natural part of aging. As a result, they put off mentioning it to their doctor and getting further testing. In fact, according to a study from the American College of Rheumatology, 72 percent of gout flares in the United States go unreported or untreated. 

You don’t have to live with chronic, nagging pain. The sooner you get diagnosed, the sooner you can get treated. Don’t wait. Schedule an appointment today. Our rheumatologists are dedicated to helping people live well with rheumatologic conditions.

FAQs

Q: Can mild or nagging joint discomfort still be a sign of gout?

A: Yes. Not every gout flare is sudden and severe. Some people have low-level aching, stiffness, or tenderness that comes and goes, or never fully clears. This can happen when uric acid crystals have built up in a joint but are causing only mild inflammation. Because these symptoms are easy to blame on aging or overuse, gout may go undiagnosed for years. If mild joint discomfort keeps returning, especially in the feet, ankles, knees, or hands, a rheumatologist can check for gout and rule out other causes.

Q: Can gout affect areas of the body that aren’t joints?

A: Yes. Gout is a joint disease at its core, but uric acid crystals can also affect tissue around and beyond the joints. Crystals can collect in tendons and bursae (the fluid-filled cushions near joints), and they can form firm lumps called tophi under the skin, often on the fingers, elbows, Achilles tendon, or ears. High uric acid can also lead to kidney stones and, over time, may affect kidney function. If you notice unexplained lumps or repeated kidney stones along with joint pain, it’s worth having your uric acid levels evaluated.

Q: Is itching or peeling skin near a joint a sign of gout?

A: It can be. As swelling from a gout flare goes down, the skin over the affected joint may become itchy, dry, or flaky, and sometimes it peels. This is often a sign that a flare has just occurred, even if the pain was mild enough to overlook. Itching or peeling alone doesn’t confirm gout, since many skin conditions look similar, but when it appears after a red, warm, swollen joint, gout is a possibility. A rheumatologist can confirm the diagnosis with a physical exam, blood tests, joint fluid analysis, or imaging.