Many forms of arthritis occur gradually, and in the early stages a person may experience only occasional mild pain. In contrast, gout strikes quickly, severely, and without warning. In fact, gout pain can be so severe that some people assume a more serious medical problem is at play, which can delay an accurate diagnosis.

Typical gout symptoms are:

Pain. The most notable symptom of gout is extreme pain at the affected joint. Gout sufferers have compared the pain to being constantly stabbed with tiny, hot knives. Typically, it is uncomfortable if not impossible for a person to put weight on an affected foot or knee.

Rapid onset. Acute gout can develop suddenly and without warning, taking only a few hours to become severely painful.7 (Though not usually the case, it is possible for gout symptoms to appear more gradually)


Symptoms interrupt sleep. It is not uncommon to hear a gout sufferer recount how a gout flare-up struck in the middle of the night, waking the person from a sound sleep. The affected joint, often a big toe, causes so much pain that the person cannot tolerate even a bed sheet resting on it.

The reason gout episodes often strike at night is that body temperature drops slightly during sleep, and this drop in temperature catalyzes the formation of uric acid crystals in the joint. This factor also helps explain why gout often affects joints in the feet and fingers - these extremities tend to maintain a lower temperature than the rest of the body.

Additionally, when a body is sleeping and joints are at rest, some of the water in the joints' synovial fluid is reabsorbed into the body. The uric acid, however, remains in the joint. The high concentration of uric acid in the joint may spur the formation of uric acid crystals.8

Only one joint is affected. In about 90% of gout cases, only one joint is affected.9 About 50% of gout cases involve the big toe, although other joints in the foot are also commonly affected, including the ankle, instep and heel. Other joints susceptible to gout include the fingertips, wrist, knee and elbow.

Short duration. Left untreated, an episode of gout can last from 3 to 10 days, or even a few weeks, during which time the pain tapers off. Usually a person's first episode of gout lasts just a few days but successive episodes may last longer.

Swelling. The affected joint swells as the uric acid crystals create irritation and inflammation.

Redness. The skin at and around the joint will appear red.

Warmth. The skin at and around the joint will be warm to the touch.

Stiffness. Swelling and pain may significantly reduce the joint's range of motion.

Fever. The person may get a fever as the immune system reacts to the uric acid crystals.

Tophi. In some cases the collection of uric acid crystals create small white chunks called tophi that can be visible through the skin. Tophi (sing. tophus) usually only occur in people who have suffered from chronic gout for several years. This is referred to as chronic tophaceous gout and is the most disabling form of gout.


Although gout symptoms normally resolve within several days or weeks, gout should not be left untreated. Over time gout can become chronic, tophi may develop, and permanent joint damage can occur.


  1. Merck Manual. Gout. Accessed May 8, 2012.
  2. eOrthopod. Gout. Accessed April 29, 2012.
  3. Harris MD, Siegel LB, Alloway JA. Gout and hyperuricemia. Am Fam Physician. 1999 Feb 15;59(4):925-34. Review. PubMed PMID: 10068714.