There are four stages of gout: Stage 1: High Uric Acid Levels: Also called asymptomatic hyperuricemia, this is the beginning stage of gout. Uric acid builds up in the blood and starts to form crystals around the joints, most often in the foot or big toe. Higher levels of uric acid can be caused by: • Overweight • Kidney disease • Taking diuretics • Drinking alcohol in excess • Diabetes • Underactive thyroid • Genes/family history • Eating a high-purine diet Stage 2: Acute Gout: During stage 2, a sudden, unexpected nighttime attack of gout symptoms may occur. This is when the urate crystals build up in the body and cause a painful inflammatory reaction. Stage 3: Intercritical Gout: Although some people can go years before another attack, after their first gout flare, 75 percent of people will have a second within a year. Stage three of gout is an in-between stage where a person has already had a gout flare but is presently not having any joint pain or swelling. Stage 4: Chronic Gout: Because the uric acid deposits can form nodules called “tophi” (singular tophus), this stage is also called “tophaceous gout.” Tophi can form anywhere in the body. During this stage, a person can have some joint pain from gout that is persistent.