Clinical manifestations of gout The disease is characterized by arthritis, gout stones and kidney damage as the main clinical manifestations. Acute gouty arthritis is the most common first symptom, with rapid onset, severe pain, mostly at night, and red, swollen and hot pain around the joints. More than half of the patients’ first joints are bunions, metatarsal toes, ankles, knees, fingers, wrists and elbows, and acute attacks can resolve on their own in a few days to a few weeks. Alcohol consumption, cold and wet, fatigue, trauma, surgery and infection are all triggering factors. Repeated attacks of acute inflammation can lead to joint stiffness and deformity. Gout stones are deposits of uric acid salts, which can be deposited anywhere, such as under the skin, in the ears, between the fingers, and near the metacarpophalangeal joints. In patients with prolonged gout, about 1/3 of them have kidney damage, mainly proteinuria and decreased urinary concentration, and chronic azotemia: development to uremic syndrome. Primary gout is complicated by uric acid urinary tract stones in 20-25% of cases, and some are even the first symptoms of gout.