4. Inflammation and edema
One of the reasons why gout is so painful is because there is an active inflammatory process in the articulation. The uric acid crystals create erosion in the articulation and damage to the joint ends. This triggers an inflammatory response localized in the trouble area, which worsens the pain and causes even more complications. One of the alterations caused by inflammation is edema. This is an accumulation of liquid in the deep layers of the skin. Edema results from cardiovascular changes in the small arteries triggered by inflammatory cytokines. There is an insufficient venous return, especially in the lower limbs, and the feet look swollen and increased in size. Swelling is worse in the affected articulation. It is more severe in worse cases of gout and pseudogout. However, some patients can experience very severe pain with no noticeable edema.