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 (three-quarters of 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 extremely sensitive to touch – even a bed sheet or someone walking in the room makes it hurt more. The swelling often spreads over the whole foot, making it impossible to put on a shoe. Also, low-grade fever may 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, over half of sufferers will have another episode within the next year. Attacks tend to strike more often, last longer, and affect more joints over time.
In some people, 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.
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.