People with gout can live normal lives. But when the disease is active, it can have a significant effect on quality of life. Gout can progress to a chronic state, and it can lead to kidney stones and chronic changes in the affected joints. The chronic stage is more likely to occur when the disease starts before the age of 30. Untreated gout can lead to permanent disability.
Left untreated, gout can develop into a painful and disabling chronic disorder. Persistent gout can destroy cartilage and bone, causing irreversible joint deformities and loss of motion. Tophi can grow to the size of handballs and can destroy bone and cartilage in the joints, similar to the process in rheumatoid arthritis. If they lodge in the spine, tophi can cause serious damage including compression, although this is very rare. In extreme cases, joint destruction results in complete disability.
Kidney stones occur in between 10% and 40% of gout patients, and can occur at any time after the development of hyperuricemia. Although the stones are usually composed of uric acid, they may also be mixed with other materials. About 25% of patients with chronic hyperuricemia develop progressive kidney disease, which sometimes ends in kidney failure. It should be noted, however, that many experts believe that chronic hyperuricemia is unlikely to be a common cause of kidney disease. In most cases, the kidney disease comes first and causes high concentrations of uric acid.
Gout often accompanies heart problems, including high blood pressure, coronary artery disease, and congestive heart failure. Hyperuricemia, in fact, has been associated with a higher risk of death from these conditions. One 2001 study reported that disease activity in gout may contribute to unhealthy cholesterol and lipid levels. Some interesting evidence, however, suggests that hyperuricemia may occur as a response to inflammatory damage that occur with heart disease and may even be protective.