About 90 percent of patients with gout are men older than 40In most of the cases gout initially affects the joints in the big toe, but it may also affect ankle, foot, knee and wrist.


In the early stage of gout uric acid level in the blood is increased but the patient does not present with any symptom. No treatment is required in this stage. The prolonged elevation of blood urate level causes deposition of uric acid crystals in the affected joint.


This causes:


  • A sudden onset of intense pain and swelling in the jointespecially the big toe.
  • The affected joint is hot, red, swollen with shiny overlying skin and dilated veins. It is extremely tender to the touch, so sensitive that the patient cannot even tolerate a brush of a bed sheet.
  • The attack usually comes at night waking the patient from sleep. It can be caused by stressful conditions, alcohol, drugs, trauma, exercise, surgery or acute illness.
  • Patient may have fever and prodromal symptoms (complaint before development of disease) like loss of appetite, nausea or change in mood.
  • When the condition is subsiding patient may have local itching and desquamation of overlying skin.


Patients with repeated attacks of gout over several years with pain free periods in between, develop chronic arthritis. Tophi which are collection of uric acid crystals form deposits in the tissue.

These usually appear under the skin around the joints and at the rim of ear. In advanced cases the kidneys are also involved resulting in formation of stones.