They may be triggered by a minor injury, surgery, consumption of large quantities of alcohol or protein-rich food, fatigue, emotional stress, or illness. The joint swells, and the skin over the joint appears red or purplish, tight, and shiny, and it feels warm. Touching the skin over the joint can be extremely painful. The disorder most often affects the joint at the base of the big toe, causing a condition called podagra, but it also commonly affects the instep, ankle, knee, wrist, and elbow. Crystals may form in these peripherally located joints because they are cooler than the central part of the body and urate tends to crystallize at cooler temperatures.
Crystals also form in the ears and other relatively cool tissues.
In contrast, gout rarely affects the spine, hips, or shoulders. Other symptoms of acute gouty arthritis can include fever, chills, a general sick feeling, and a rapid heartbeat. Gout tends to be more severe in people who develop symptoms before age 30. Usually, gout develops during middle age in men and after menopause in women. The first few attacks usually affect only one joint and last for a few days.