Triggering factors include full meals and alcohol consumption, excessive fatigue, stress, localized joint injury, surgery, and exposure to cold and moisture. Most people have no prodromal symptoms or systemic manifestations, but a few may have fever, headache, nausea, elevated white blood cells, and increased blood sedimentation. The onset of the disease is rapid, often waking up at midnight or early in the morning, with obvious redness, swelling and burning of the joints, severe pain like cutting or biting, and the pain reaches its peak in 24-48 hours, and mostly relieves itself within a few days or weeks. The pain peaks within 24-48 hours and resolves on its own within a few days or weeks. The pain is accompanied by significant tenderness and may include joint effusion. The first attack is usually monoarthritis of the lower extremities, with 60-70% of the first attacks occurring in the first metatarsophalangeal joint, which is repeatedly involved in 90% of patients during the course of the disease. This is followed by the tarsometatarsal, ankle, knee, finger, wrist, and elbow joints, and is rare in the medial joints.