Stages of gout

What stages of gout should be distinguished?

George Nuki: I think the traditional division of gout into stages, which were a matter of hypothesis to begin with, was into 4 stages: beginning with asymptomatic hyperuricemia, then starting with acute attacks, having a long period of interval gout, following up with chronic ongoing inflammatory disease. In a way, that has been justified by the findings with new imaging methods, both ultrasound and dual x-ray, so dual-energy computed tomography (DECT) studies. But on the other hand, it has also shown us that gout is a chronic inflammatory disease, even at the time of the first attack. And we know now that about 30% of people with asymptomatic hyperuricemia actually have evidence of crystal deposition. The challenge for research now is to determine which patients with asymptomatic hyperuricemia are developing crystal deposition because many patients, of course, never do.