The symptoms of a gout attack are almost unmistakeable. Typically, a person will go to bed feeling fine, then wake up during the night with intense pain in the big toe (more than half of first-time gout cases involve this joint). At first it feels like a bucket of cold water has been poured over the joint, but soon there's an agonizing sensation of stretching and tearing, along with pressure and tightness. The affected area also becomes red, hot, and extremely sensitive to touch – even a bed sheet can make it hurt more. The swelling often spreads over more of the foot, making it impossible to put on a shoe. A low-grade fever may also develop.
An attack will usually taper off on its own in 3 to 10 days, but prompt treatment can end it faster. After such an attack, called acute gout or acute gouty arthritis, most sufferers will have another episode within the next two years. Attacks tend to strike more often, last longer, and affect more joints over time.
Very rarely, however, the attacks don't go away – instead, they linger on to become chronic gout. The inflammation persists, while the crystals can permanently damage and deform the affected joints. As well, uric acid crystals can build up in tissues other than the joints, forming deposits called tophi that can show up as whitish or yellowish chalky lumps under the skin, typically in the fingers, toes, back of the elbow, behind the heel, and around the outer edge of the ear. The tophi sometimes poke through the skin, leading to ulcerations or sores.
People with gout are at higher risk of cardiovascular disease, including atherosclerosis (hardening of the arteries, which can lead to heart attack and stroke). It is not clear whether high uric acid levels play a role in developing atherosclerosis, but most people with gout also have high visceral fat and other risk factors for atherosclerosis, such as high blood pressure, blood sugar, and blood cholesterol. These risks can be markedly reduced by a healthy lifestyle and medications as indicated.
Gout can cause kidney stones, which can cause symptoms such as severe flank or groin pain, and sometimes blood in the urine. It is unclear as to what degree gout can damage the kidneys besides the effects of kidney stones.