Gout

A gout "flare" (attack) usually strikes suddenly, at night, in one location (usually the large joint in the big toe). During the attack, the area becomes hot, red, swollen, and extremely tender. A fever may also be present. The pain, which can be excruciating, usually peaks within 24 hours.

The primary risk factor for gout is hyperuricemia—high levels of uric acid in the blood. People who have this condition are at risk of having an attack of gout. This risk appears to increase with higher uric acid levels. No one can predict when an attack might occur for someone with hyperuricemia. It may be triggered by alcohol, certain medicines, the presence of another illness, stressful events, or some other factor. Many times it may be difficult to say what triggered a specific attack. Having your healthcare provider measure your uric acid levels may help predict your chances of having a future attack.

With or without treatment, the symptoms usually go away within 3 to 10 days, and the next attack may not occur for months or even years, if at all. However, over time attacks can become more severe, last longer, and occur more often.

Although 90% of people with gout have an attack in their big toe, other joints affected may be the instep, ankle, knee, wrist, and fingers. The symptoms usually come without warning, but some people have minor pain in the ankle, soreness in the heel, or twinges of pain in the big toe before the attack.
There's more to gout than the pain of attacks. Hyperuricemia—the primary risk factor for gout—may affect your joints even when you aren't having a painful flare.

People over 60 years of age may experience different symptoms of gout. For example, joints in the upper part of their body are more likely to be affected, and more than one joint may have symptoms at the same time. Older people may also have an increased risk of developing “tophi”—crystal deposits made up of uric acid found around tissues of joints affected by gout.