Most episodes of gout begin as arthritis in a single joint (often in the toes or knees), with flare-ups typically occurring at night or the early morning.
The big toe is the most frequent site of acute gouty arthritis, marked by significant pain, warmth, redness and swelling, and occasionally a low-grade fever or chills. Malaise, or depression, is also not uncommon.
Over time, the instep of the foot, ankles, heels, knees, wrists, fingers and elbows also become affected; in some cases, redness and swelling can spread, as can the occurrence of painful nodes between the skin, and the elbow, kneecap, and Achilles tendon. Gout will almost never affect joints close to the spine.
A flare-up of gouty arthritis can resolve on its own between three and 10 days following the initial attack, but subsequent instances can occur more frequently over time, affecting both pairs of a joint type, and for longer periods of time. Gout sufferers should treat not only the symptoms of the disease, but also work with their physician to understand the underlying cause, so it can be addressed and future outbreaks contained, if not completely eliminated.