Hypersensitivity, pain, temperature increase, swelling and redness are seen in the joints where uric acid crystals accumulate and cause joint inflammation. The area of skin over the affected joint is shiny and sometimes peeling may occur. Attacks are most common at the root of the big toe and usually begin at night. The onset of symptoms is within a few hours. The slightest contact with the painful joint, even the touch of a bedding, can cause severe tenderness and discomfort.
Although it is most often in the big toe, it can also occur in other foot joints, ankles, knees, elbows, and more rarely hand joints and wrists. It usually manifests itself in one or several joints. In the following years, joint inflammation may develop in many joints at the same time in untreated conditions. It is very rare to occur in joints close to the body center such as the spine, hips, and shoulders.
Uric acid crystals may also accumulate in extra-articular sites. It may be in the form of small, hard, white nodules called “Tophi” in the subcutaneous region. These lumps are usually painless, but sometimes tearing the lump can ooze a cheesy-white material that looks like uric acid crystals pus.
