Symptoms of acute gouty attacks:

• Symptoms develop suddenly and usually involve only one or a few joints. The big toe, knee, or ankle joints are most often affected.
• The pain frequently starts during the night and is often described as throbbing, crushing, or excruciating.
• The joint appears warm and red. It is usually very tender (it hurts to lay a sheet or blanket over it).
• There may be a fever.
• The attack may go away in several days, but may return from time to time. Additional attacks usually last longer.

After a first gouty attack, people will have no symptoms. Some people will go months or even years between gouty attacks.

Some people may develop chronic gouty arthritis, but others may have no further attacks. Those with chronic arthritis develop joint deformities and loss of motion in the joints. They will have joint pain and other symptoms most of the time.

Tophi are lumps below the skin around joints or in other places. They may drain chalky material. Tophi usually develop only after a patient has had the disease for many years.

After one gouty attack, more than half of people will have another attack.

Tests that may be done include:

• Synovial fluid analysis (shows uric acid crystals)
• Uric acid - blood
• Joint x-rays (may be normal)
• Synovial biopsy
• Uric acid - urine