The first symptom of gouty arthritis is typically the sudden onset of a hot, red, swollen joint. The most common joint involved is at the base of the big toe (podagra), but almost any joint can be involved. In some people, the acute pain is so intense that even a bed sheet on the joint causes pain.
Even without treatment, the first attacks stop spontaneously after 1-2 weeks. While the pain and swelling completely go away, gouty arthritis almost always returns in the same joint or in another joint.
With time, attacks of gouty arthritis occur more frequently and tend to last longer. While the first attacks usually involve only one or two joints, over time multiple joints can be involved simultaneously.
Kidney stones are more frequent in patients with gout.
Uric acid crystals can form outside joints. Collections of these crystals, known as tophi, can be found in the earlobe, elbow, and Achilles tendon (back of the ankle). Typically, these tophi are not painful but can be a valuable clue for the diagnosis.
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