Early Gout Symptoms You Shouldn’t Ignore + Why They May Differ for Women
A rheumatologist says early detection is key for preventing long-term joint damage
If you’ve ever been going about your day only to get hit with excruciating joint pain, it could be gout. While this type of arthritis is often associated with sharp, sudden pain in the big toe, gout symptoms in women are often not as straightforward as they are in men. Women may experience early-stage gout symptoms in smaller joints like the hands, wrists or feet, where it can develop more gradually and can be harder to spot.
“As people with gout know, flare-ups can be debilitating,” says Brittany Panico, DO, an Arizona-based rheumatologist. “It’s often sudden, but sometimes it creeps up on you. This makes gout especially tricky, because it often doesn’t show up the way we expect. But if left untreated, it can lead to joint damage.”
The good news? Learning the early warning signs can help you spot gout sooner so you can visit your doctor and manage the condition before it progresses.
Woman's World Answers
What is gout?
Gout is a form of inflammatory arthritis caused by a buildup of uric acid in the body. When the kidneys aren’t able to efficiently eliminate uric acid, it accumulates and forms sharp crystals in the joints.
This leads to sudden, intense pain, swelling and redness, most commonly in the big toe (though it can potentially affect other joints, too). Gout attacks typically last between three to 10 days and can cause significant discomfort and inflammation.
Gout symptoms: What does gout feel like?
When a gout flare strikes, it’s not just a little soreness. The affected joint can feel like it’s on fire or if it’s in your foot, like you’re stepping on broken glass.
“It’s an intense pain and swelling that can come on suddenly, often waking people up in the middle of the night,” says Dr. Panico. “Even the lightest touch, like a bedsheet brushing against the skin, can feel unbearable.”
But when women experience gout symptoms in smaller joints (rather than isolated to the big toe), the symptoms can be more subtle and gradual. “This is one reason it’s often misdiagnosed as another type of arthritis, such as rheumatoid arthritis,” she adds.
Early-stage gout symptoms in women might also be mistaken for osteoarthritis (OA), with stiffness and swelling in the hands dismissed as a normal part of aging, Dr. Panico says.
Gout symptoms: What does gout look like?
Visually, gout can cause a joint to become red, swollen and shiny—sometimes even purple—and the skin may look stretched, a hallmark of intense inflammation.
“It can be so swollen that the skin looks almost ready to burst. This can be mistaken for cellulitis, a bacterial infection, so many women end up being treated with antibiotics instead of the right medication for gout,” Dr. Panico explains.
However, in women, the swelling might not be as obvious or it could affect multiple joints. You might see enlarged knuckles or a swollen ankle that doesn’t go away.
“It can appear in chronic, subtle ways, with the swelling ebbing and flowing,” Dr. Panico says. “Sometimes, the skin can start peeling like a sunburn when the swelling goes down.”
In severe cases, gout can lead to the development of tophi—white, chalky deposits of uric acid crystals that form under the skin, often on the elbows or fingers. These lumps are a strong indicator that gout is present, and they are a clear sign that high levels of uric acid have been building up in the body for some time.
Gout symptoms can affect women differently
Gout tends to affect men earlier than women. Men usually develop gout in their 30s or 40s, whereas women typically experience it later, around the age of 60 or after menopause. “Estrogen helps the kidneys eliminate uric acid, and when estrogen levels drop, uric acid builds up in the joints,” Dr. Panico adds.
Many women with gout, especially in the early stages, will have normal uric acid levels in their blood. “This makes diagnosis tricky,” Dr. Panico warns. “Even if blood tests show normal levels, uric acid crystals can still be forming in the joints.”
Risk factors for gout
- Hormonal changes after menopause
- Hypertension and kidney disease, which impair the kidneys’ ability to filter uric acid
- Certain medications, like diuretics prescribed for high blood pressure, can raise uric acid levels
- A diet that contains high-purine foods like red meat, shellfish and alcohol can contribute to gout flare-ups (learn how a gout diet can ease symptoms here)
- Obesity and metabolic syndrome increase both uric acid levels and inflammation
- A family history of gout combined with high uric acid levels increases your risk
How gout is diagnosed and treated
If you’re experiencing joint pain that fluctuates or doesn’t improve with treatment, it’s important to consult your doctor. Since gout often overlaps with other forms of arthritis, proper testing is essential, says Dr. Panico.
Gout is diagnosed by testing for high levels of uric acid in your blood and analyzing joint fluid for uric acid crystals. Additionally, imaging tests like an ultrasound and dual-energy CT scan can help identify deposits in the joints and soft tissue.
“The sooner we catch it, the better we can manage it and prevent long-term joint damage,” Dr. Panico advises.
Gout treatment involves two key steps: managing flare-ups and long-term prevention. During a flare, NSAIDs, prescribed medications or steroids are used to reduce inflammation and pain. For long-term management of gout symptoms, medications are prescribed to reduce uric acid levels in the body.
Dr. Panico stresses that lifestyle changes can help manage gout, too. “Drink plenty of fluids to stay hydrated, maintain a healthy weight and avoid foods high in purines, such as red meat and shellfish, to help reduce flare-ups,” she says. (Check out our guide to treating gout flare-ups here.)
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