Intense, ongoing pain in one joint, usually the big toe, that seems to have come on for no reason.
Hot, red swollen skin and a feeling of pressure around the painful area. There may also be the feeling that the skin around the area is stretching or tearing.
The onset of gout is usually quick and unexpected. Often, people who develop gout will do so during the night while sleeping, after having gone to bed in good health. During the night, they are awakened by acute pain in the big toe or, more rarely, in the heel, ankle or instep. This pain has been described as feeling at first like a bucket of cold water has been poured over the affected area, with the pain increasing to a violent stretching, tearing sensation. There is also a pressure and tightness around the area, and the pain becomes so acute that not even the weight of a bed sheet can be tolerated. The soft tissues, such as the muscles and tendons, around the joint can become hot, red and swollen, and wearing of a regular shoe may become impossible.
Gout typically affects the joint at the base of the big toe. In over half of all initial attacks, this is the first joint affected. Almost any other joint can be affected, but the joints of the lower limbs are more commonly than those of the upper limbs.
The majority of initial gout attacks involve only one joint, and, with treatment, subside within three to ten days. Over 50% of people who have had an acute attack of gout will have a recurrence within the year. Over time the attacks may become more frequent, longer lasting and often involve more joints.
For some people the attacks linger, and the disease becomes chronic. The crystals of uric acid deposited inside the joint and in the surrounding soft tissues lead to destructive changes in the joint and cause persistent inflammation.
Uric acid crystals can be deposited in soft tissues and form what are known as 'tophi.' These appear as whitish or yellowish deposits under the skin. They cause local irritation of the soft tissues, leading to redness of the area. Sometimes the deposits can break through the skin. Tophi may occur at any site but commonly occur in the fingers or toes, at the backs of the elbows, behind the heels, or around the outer edges of the ears. Uric acid crystals can also form deposits in the kidney or urinary tract.