There are four stages of gout, a common and often painful condition affecting joints, most often the big toe.

Gout is a form of inflammatory arthritis caused by hyperuricemia. Hyperuricemia is a condition that occurs when uric acid builds up in your body. Not everybody with hyperuricemia develops gout, but people who do develop crystals in joints like their big toes that cause sudden and sharp pain.

Gout progresses through four stages. In the first stage, uric acid levels build up in your blood, but you don’t experience any symptoms. In the final stage, large crystals called tophi can cause joint damage and structural changes.

Read on to learn more about the four stages of gout.

Gout progresses through four stages. With proper treatment, you may never reach the final stage. Here’s a look at each of these stages.

Stage 1: Asymptomatic gout

In the first stage, gout doesn’t cause symptoms. Uric acid starts to build up in your blood and possibly in your joints. The buildup of uric acid is called hyperuricemia.

Experts define hyperuricemia as uric acid levels above 6 milligrams per deciliter (mg/dL) in females and 7 mg/dL in males.

Uric acid is a byproduct of the breakdown of purines. You can find purines in the following:

  • alcoholic drinks
  • shellfish
  • some meats like bacon, turkey, and organ meats

Learn more about foods that contain purines.

Stage 2: Acute gout

In the acute stage, also called a gout flare-up, uric acid seeps out of your blood, leading to crystal formations in one or more joints. Symptoms develop due to an immune reaction to the crystals.

Gout usually only involves one joint at a time, with the big toe most often affected.

Initial flare-ups usually resolve within 3–14 days, even without treatment, but future flare-ups can last longer. Symptoms can include:

  • sharp pain that onsets suddenly
  • swelling
  • redness or discoloration
  • hot skin

Learn more about gout flare-ups and symptoms.

Stage 3: Intercritical or interval gout

In the third stage of gout, your symptoms go away until you have another flare-up that can occur weeks to years later.

Even though you don’t have symptoms during this stage, uric acid levels can build up in your blood and joints. A doctor may prescribe medications to prevent future flares.

Learn more about medications for gout flares.

Stage 4: Chronic tophaceous gout

If managing your uric acid levels is difficult, your gout may progress to the final stage. It usually takes 10 years or more to enter the final stage.

Large crystals called tophi can build up and appear as bumps under your skin at this stage. These tophi can lead to:

  • joint damage
  • structural changes
  • infections

You might also develop other health concerns like painful joints or kidney stones. Tophi may develop in your cornea or heart valves.

Gout isn’t usually preventable since your genetics can play a large role in its development. Up to 50% of people in the United States may have a family history. But you can prevent the acute stage by avoiding your triggers as much as possible. Common triggers include:

  • stress
  • illness
  • surgery
  • injury
  • dehydration
  • malnutrition
  • consumption of high purine foods

Gout often links to some other health conditions that are largely preventable, such as:

Adopting lifestyle changes to avoid developing these conditions could help reduce your chances of developing gout symptoms by improving kidney function.

Learn more about the link between gout and diabetes.

Gout doesn’t have a cure, but receiving proper treatment can help prevent long-term complications. With treatment, many people never reach the chronic stage.

Potential treatments include:

Learn more about gout treatment.

Here are some frequently asked questions people have about gout.

When does gout become serious?

The acute stage of gout can cause intense pain in one or more joints. The final stage causes significant joint damage and structural changes.

Does walking on gout make it worse?

Walking when you have a gout flare-up may lead to increased swelling or structural changes that cause other lower body difficulties. It may be a good idea to avoid walking when you have a gout flare-up if you find it painful.

What is the last stage of gout?

The last stage of gout involves the presence of tophi or large crystals that can cause joint damage and structural changes. Many people never reach this stage if they manage gout properly.

Gout progresses through four stages. In the first stage, you may have elevated uric acid levels in your blood but no noticeable symptoms. In the final stage, gout can cause permanent damage and structural changes in your joint.

Gout isn’t usually preventable, but receiving proper treatment and managing uric acid levels in your blood can help you prevent it from progressing to a later stage.