Acute gouty arthritis is characterized by a rapid onset of severe pain, swelling and erythema most commonly in the metatarsal-phalangeal joint. Acute gout is normally monoarticular and may also occur in the ankle or knee. Acute gout may be set off by trauma, illness or excess consumption of high protein food and alcohol and begins most commonly at night. Patients may have a low grade fever and leukocytosis. Untreated acute gout subsides in 3-10 days.
Intercritical gout refers to the asymptomatic periods between attacks.
Chronic tophaceous gout occurs an average of 12 years after the first gout attack. Tophi occur within the synovium, subchondral bone, tendon and subcutaneous tissue resulting in osseous erosion, tendon rupture and carpal tunnel syndrome. Patients with gout usually have a well known history and are not subject to extensive radiologic examination. Acute gout attacks may appear as soft tissue swelling, osteopenia or a-joint effusion on plain film. Signs of late gout include polyarticular involvement of asymmetric joints.