Many forms of arthritis occur gradually, and in the early stages a person may experience only occasional mild pain. In contrast, gout often strikes quickly, severely, and without warning.

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Swelling is one of the most common symptoms of gout, often in the ankle, foot, or knee.

Pain

The most notable symptom of gout is extreme pain in the affected joint. Gout pain has been compared to being constantly stabbed with tiny, hot knives.

Extreme Tenderness

Touching the skin over the affected joint can be painful. Even covering the skin over the affected joint with clothing or a light blanket can elicit severe pain.

Swelling

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

Reduced Joint Function

Pain, tenderness, and swelling can significantly limit the joint’s range of motion and ability to function. It may be uncomfortable—or even impossible—to put weight on an affected foot or knee.

Changes to the Skin

The skin at and around the joint will be red and warm to the touch. The skin may also become visibly stretched.

Rapid Onset

A gout attack can develop suddenly and without warning, taking only a few hours to become severely painful. The worst pain usually occurs within the first 24 hours. ¹ Sidari A, Hill E. Diagnosis and Treatment of Gout and Pseudogout for Everyday Practice. Prim Care. 2018;45(2):213-236. doi:10.1016/j.pop.2018.02.004 (While not typical, gout symptoms can appear more gradually.)

Symptoms that Interrupt Sleep

It is not uncommon for gout to flare-up in the middle of the night, waking a 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.

A Single Joint that is Affected

In many gout attacks, only one joint is affected. ² Harris MD, Siegel LB, Alloway JA. Gout and hyperuricemia. Am Fam Physician. 1999 Feb 15;59(4):925-34. PMID: 10068714. The big toe, ankle, foot instep, heel, or knee is most likely to be affected.

Flu-like Symptoms

A gout attack may also cause fever, fatigue, and a general feeling of being unwell. These flu-like symptoms are more common when more than one joint is inflamed. ¹ Sidari A, Hill E. Diagnosis and Treatment of Gout and Pseudogout for Everyday Practice. Prim Care. 2018;45(2):213-236. doi:10.1016/j.pop.2018.02.004

Short Duration

If left untreated, gout pain typically tapers off and goes away within 10 to 14 days. ¹ Sidari A, Hill E. Diagnosis and Treatment of Gout and Pseudogout for Everyday Practice. Prim Care. 2018;45(2):213-236. doi:10.1016/j.pop.2018.02.004 ^, ³ Slobodonick A, Toprover M, Pillinger M. Crystal Arthritis. In: Efthimiou P, ed. Absolute Rheumatology Review. Springer Nature Switzerland AG; 2020; chap 15. Accessed September 15, 2020. https://doi.org/10.1007/978-3-030-23022-7_15 A person’s first episode of gout may last just a few days while successive episodes may last longer.

Tophi

Uric acid crystals can collect together and create small white chunks, called tophi, that can be seen and felt through the skin. Tophi (sing. tophus) usually only occur in people who have had chronic gout for several years or longer. This condition 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.