Symptoms:

Symptoms of acute gout:

• Symptoms usually involve only one or a few joints. The big toe, knee, or ankle joints are most often affected.
• The pain starts suddenly, often during the night and is often described as throbbing, crushing, or excruciating.
• The joint appears warm and red. It is usually very tender (it hurts to lay a sheet or blanket over it).
• There may be a fever.
• The attack may go away in a few days, but may return from time to time. Additional attacks often last longer.

After a first gouty attack, people will have no symptoms. Half of patients have another attack.

Some people may develop chronic gout. Those with chronic arthritis develop joint damage and loss of motion in the joints. They will have joint pain and other symptoms most of the time.

Tophi are lumps below the skin around joints or in other places. They may drain chalky material. Tophi usually develop only after a patient has had the disease for many years.

Signs and tests:

Tests that may be done include:

• Synovial fluid analysis (shows uric acid crystals)
• Uric acid - blood
• Joint x-rays (may be normal)
• Synovial biopsy
• Uric acid - urine

Not everyone with high uric acid levels in the blood has gout.