Clinical Features

Gout usually occurs in attacks, which may last for a few days to about 2 weeks. Usually there are long periods between attacks.

An attack may be accompanied by fever, confusion and the person may feel very unwell. Typically an attack develops quickly over a few hours often during the night, waking the individual in the early hours of the morning.

Commonly severe pain, inflammation and swelling occur in one joint, often the big toe, but in up to a third of people the attack starts elsewhere. Sometimes more than one joint or soft tissues (muscle, tendons, and tissues below the skin) may be affected by inflammation.

The first few attacks of gout do not cause any permanent joint damage and full recovery of the joint can be expected.

Over time, attacks tend to become more frequent and last for longer. If untreated repeated attacks of gout lead to joint damage and chronic (longstanding and persistent) pain.

Uric acid may also be deposited beneath the skin causing visible hard white lumps called tophi.

Crystals may cause problems elsewhere and may lead to stones forming in the kidneys.